Healthcare Provider Details

I. General information

NPI: 1871665372
Provider Name (Legal Business Name): ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 INDIAN HILLS DR
GLENWOOD IA
51534-1953
US

IV. Provider business mailing address

PO BOX 1C
COUNCIL BLUFFS IA
51502-3001
US

V. Phone/Fax

Practice location:
  • Phone: 712-527-2049
  • Fax:
Mailing address:
  • Phone: 402-527-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number65PM28
License Number StateIA

VIII. Authorized Official

Name: EVERT KUIPER
Title or Position: CEO
Credential:
Phone: 402-343-4420