Healthcare Provider Details

I. General information

NPI: 1083784912
Provider Name (Legal Business Name): IDA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 FIRST
BATTLE CREEK IA
51006-0016
US

IV. Provider business mailing address

PO BOX 16
BATTLE CREEK IA
51006-0016
US

V. Phone/Fax

Practice location:
  • Phone: 712-365-4339
  • Fax: 712-365-4566
Mailing address:
  • Phone: 712-365-4339
  • Fax: 712-365-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberNA
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGARET ANN JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 712-365-4339