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General NPI Number Information
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NPI Number | 1437584497
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Entity Type | Organization
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Legal Business Name | LINN COUNTY
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1240 26TH AVENUE CT SW
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-3402
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Country | US
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Telephone | 319-892-5606
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Fax | 319-892-5619
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Provider Business Mailing Address
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Address Line | 1240 26TH AVENUE CT SW
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-3402
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Country | US
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Telephone | 319-892-5606
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Fax | 319-892-5619
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JIM NAGEL
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Credential |
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Telephone | 319-892-5803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 0740241
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License Number State | IA
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