Healthcare Provider Details

I. General information

NPI: 1477594141
Provider Name (Legal Business Name): LEWIS CENTRAL CSD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E SOUTH OMAHA BRIDGE
COUNCIL BLUFFS IA
51503
US

IV. Provider business mailing address

1600 E SOUTH OMAHA BRIDGE
COUNCIL BLUFFS IA
51503
US

V. Phone/Fax

Practice location:
  • Phone: 712-366-8311
  • Fax: 712-366-8315
Mailing address:
  • Phone: 712-366-8311
  • Fax: 712-366-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURIE S THIES
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 712-366-8311