Healthcare Provider Details

I. General information

NPI: 1427221647
Provider Name (Legal Business Name): MIDWEST TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 HIGHWAY 218
MONTROSE IA
52639
US

IV. Provider business mailing address

2818 HWY 218
MONTROSE IA
52639
US

V. Phone/Fax

Practice location:
  • Phone: 319-463-5592
  • Fax:
Mailing address:
  • Phone: 319-463-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberPENDING
License Number StateIA

VIII. Authorized Official

Name: BEN TRANE
Title or Position: DIRECTOR
Credential:
Phone: 319-524-3560