Healthcare Provider Details

I. General information

NPI: 1558875062
Provider Name (Legal Business Name): SAIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 SUMNER AVE
HUMBOLDT IA
50548-1763
US

IV. Provider business mailing address

303 2ND AVE N
HUMBOLDT IA
50548-1610
US

V. Phone/Fax

Practice location:
  • Phone: 712-660-0575
  • Fax:
Mailing address:
  • Phone: 712-660-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HALEY FITZPATRICK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 712-660-0575