MEDICARE: ZION INTEGRATED BEHAVIORAL HEALTH SERVICES INC.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1267	IA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68236	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1528288263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZION INTEGRATED BEHAVIORAL HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	PO BOX 34
Second Line	:
City	:	ATLANTIC
State	:	IA
Zip	:	50022-0034
Country	:	US
Telephone Number	:	712-243-5091
Fax Number	:	712-243-1337

Provider Business Practice Location Address
First Line	:	2307 OLIVE ST
Second Line	:
City	:	ATLANTIC
State	:	IA
Zip	:	50022-9768
Country	:	US
Telephone Number	:	712-243-5091
Fax Number	:	712-243-1337

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LAURIE JEAN HERRICK COOLEY
Credential	:
Telephone Number	:	712-243-5091

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	04/15/2024

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308