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NPI Code Detail

MEDICARE: NORTH IOWA JUVENILE DETENTION SERVICES

MEDICARE: NORTH IOWA JUVENILE DETENTION SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2313M00000XNursing Facility/Intermediate Care Facility
3320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1174976757
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH IOWA JUVENILE DETENTION SERVICES
Provider Business Mailing Address
First Line : 1440 W DUNKERTON RD
Second Line :
City : WATERLOO
State : IA
Zip : 50703-9648
Country : US
Telephone Number : 319-291-2455
Fax Number : 319-291-2464
Provider Business Practice Location Address
First Line : 1440 W DUNKERTON RD
Second Line :
City : WATERLOO
State : IA
Zip : 50703-9648
Country : US
Telephone Number : 319-291-2455
Fax Number : 319-291-2464
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : AMBER LACINA
Credential : BSN, RN, MSN, APMHNP
Telephone Number : 319-291-2455
Provider Enumeration Date : 07/19/2016
Last Update Date : 01/16/2025

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Directions to “NORTH IOWA JUVENILE DETENTION SERVICES ” Practice Location

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