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General NPI Number Information
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NPI Number | 1558415943
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Entity Type | Organization
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Legal Business Name | FHC OF STORM LAKE IOWA INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1815 W MILWAUKEE AVE
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City | STORM LAKE
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State | IA
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Zip | 50588-0243
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Country | US
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Telephone | 712-732-5127
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Fax | 712-732-6002
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Provider Business Mailing Address
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Address Line | PO BOX 243
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City | STORM LAKE
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State | IA
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Zip | 50588-0243
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Country | US
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Telephone | 712-732-5127
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Fax | 712-732-6002
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THOMAS G DANIELS
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Credential |
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Telephone | 712-732-5117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | IMR439
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License Number State | IA
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