1205912094 NPI number — DICKINSON COUNTY

Table of content: (NPI 1205912094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205912094 NPI number — DICKINSON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DICKINSON COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205912094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1802 HILL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPIRIT LAKE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51360-1259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-336-0775
Provider Business Mailing Address Fax Number:
712-336-4961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E 11TH ST
Provider Second Line Business Practice Location Address:
SEASONS CENTER FOR COMMUNITY MENTAL HEALTH
Provider Business Practice Location Address City Name:
SPENCER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51301-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-242-5101
Provider Business Practice Location Address Fax Number:
712-262-3826
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILL
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DICKINSON COUNTY CPC
Authorized Official Telephone Number:
712-336-0775

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0746925 . This is a "CASE MANAGEMENT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0085324 . This is a "CASE MANAGEMENT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0457879 . This is a "CASE MANAGEMENT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".