1467514869 NPI number — REM IOWA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467514869 NPI number — REM IOWA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REM IOWA, INC
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:
1467514869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 INDUSTRIAL AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-393-1944
Provider Business Mailing Address Fax Number:
319-393-2091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 N 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52353-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-653-7360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODENBERG-ROBERTS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
VP & SR ASST GENERAL COUNSEL
Authorized Official Telephone Number:
952-836-2234

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0880559 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0880559 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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