Healthcare Provider Details

I. General information

NPI: 1083707939
Provider Name (Legal Business Name): DES MOINES COUNTY COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 COTTONWOOD SUITE 1000
BURLINGTON IA
52601-1994
US

IV. Provider business mailing address

910 COTTONWOOD SUITE 1000
BURLINGTON IA
52601-1994
US

V. Phone/Fax

Practice location:
  • Phone: 319-754-8556
  • Fax: 319-754-8854
Mailing address:
  • Phone: 319-754-8556
  • Fax: 319-754-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MARSTON
Title or Position: CASE MANAGEMENT SUPERVISOR
Credential:
Phone: 319-754-8556