Healthcare Provider Details

I. General information

NPI: 1700953874
Provider Name (Legal Business Name): NORTHEAST IOWA COMMUNITY ACTION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MONTGOMERY ST
DECORAH IA
52101-2721
US

IV. Provider business mailing address

305 MONTGOMERY ST PO BOX 487
DECORAH IA
52101-2721
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-8436
  • Fax: 563-382-5140
Mailing address:
  • Phone: 563-382-8436
  • Fax: 563-382-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ANN HUMPAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-382-8436