1679652960 NPI number — NORTH IOWA TRANSITION CENTER

Table of content: (NPI 1679652960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679652960 NPI number — NORTH IOWA TRANSITION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH IOWA TRANSITION CENTER
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:
1679652960
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:
PO BOX 1503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50402-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-424-8708
Provider Business Mailing Address Fax Number:
641-421-7809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-424-8708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLEILE
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
641-424-8708

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  RCFPMI 501 , 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: 0892612 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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