Healthcare Provider Details

I. General information

NPI: 1295886232
Provider Name (Legal Business Name): SOUTHWEST IOWA CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E MAIN ST
CLARINDA IA
51632-2141
US

IV. Provider business mailing address

112 E MAIN ST
CLARINDA IA
51632-2141
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-2983
  • Fax: 712-542-2370
Mailing address:
  • Phone: 712-542-2983
  • Fax: 712-542-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberIAC- CHAPTER 24
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MS. JANE MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 712-542-2983