Healthcare Provider Details

I. General information

NPI: 1841348836
Provider Name (Legal Business Name): LINN COUNTY MHDD SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 2ND AVE SE
CEDAR RAPIDS IA
52401-1215
US

IV. Provider business mailing address

305 2ND AVE SE
CEDAR RAPIDS IA
52401-1215
US

V. Phone/Fax

Practice location:
  • Phone: 319-892-5620
  • Fax: 319-892-5677
Mailing address:
  • Phone: 319-892-5620
  • Fax: 319-892-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0095224
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. CRAIG E WOOD
Title or Position: LINN COUNTY CPC
Credential:
Phone: 319-892-5620