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General NPI Number Information
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NPI Number | 1174976757
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Entity Type | Organization
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Legal Business Name | NORTH IOWA JUVENILE DETENTION SERVICES
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 1440 W DUNKERTON RD
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City | WATERLOO
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State | IA
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Zip | 50703-9648
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Country | US
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Telephone | 319-291-2455
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Fax | 319-291-2464
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Provider Business Mailing Address
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Address Line | 1440 W DUNKERTON RD
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City | WATERLOO
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State | IA
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Zip | 50703-9648
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Country | US
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Telephone | 319-291-2455
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Fax | 319-291-2464
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AMBER LACINA
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Credential | BSN, RN, MSN, APMHNP
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Telephone | 319-291-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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