Healthcare Provider Details

I. General information

NPI: 1508048992
Provider Name (Legal Business Name): HOWARD COUNTY CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 2ND ST E
CRESCO IA
52136-1602
US

IV. Provider business mailing address

205 2ND ST E
CRESCO IA
52136-1602
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-3966
  • Fax: 563-547-3117
Mailing address:
  • Phone: 563-547-3966
  • Fax: 563-547-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MS. SUSAN J SPILDE
Title or Position: DIRECTOR
Credential: LBSW
Phone: 563-547-3966