1619039096 NPI number — REM IOWA, INC

Table of content: (NPI 1619039096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619039096 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:
1619039096
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:
3025 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52302-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-377-1097
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: 0880484 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0880484 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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