1487620068 NPI number — SOLUTION ENTERPRISES

Table of content: (NPI 1487620068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487620068 NPI number — SOLUTION ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLUTION ENTERPRISES
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:
6
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:
1487620068
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:
11963 580TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STORY CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50248-8745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-979-5661
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 WILLSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50595-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-979-5661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GERDES
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
515-979-5661

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01664 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007810669 . This is a "AETNA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 39883 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 100059455001 . This is a "APS HEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 9357788 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 110623 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 38042 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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