Healthcare Provider Details

I. General information

NPI: 1578560256
Provider Name (Legal Business Name): AREA SUBSTANCE ABUSE COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 16TH AVE SW
CEDAR RAPIDS IA
52404-2328
US

IV. Provider business mailing address

3601 16TH AVE SW
CEDAR RAPIDS IA
52404-2328
US

V. Phone/Fax

Practice location:
  • Phone: 319-390-4611
  • Fax: 319-390-4381
Mailing address:
  • Phone: 319-390-4611
  • Fax: 319-390-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1221
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEPHANIE BOESENBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 319-390-4611