Healthcare Provider Details

I. General information

NPI: 1457401754
Provider Name (Legal Business Name): GRUNDY COUNTY CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 H AVE COURTHOUSE ANNEX
GRUNDY CENTER IA
50638-1410
US

IV. Provider business mailing address

704 H AVE COURTHOUSE ANNEX
GRUNDY CENTER IA
50638-1410
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-6779
  • Fax: 319-824-6921
Mailing address:
  • Phone: 319-824-6779
  • Fax: 319-824-6921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. LORI ALESE BYERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 319-824-6779