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NPI Code Detail

MEDICARE: AREA SUBSTANCE ABUSE COUNCIL, INC.

MEDICARE: AREA SUBSTANCE ABUSE COUNCIL, INC.
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
1101YA0400XAddiction (Substance Use Disorder) CounselorIA
2251S00000XCommunity/Behavioral Health Agency1221IA

General Provider Information

NPI Number : 1578560256
Entity Type Code : Organization
Provider Name (Legal Business Name) : AREA SUBSTANCE ABUSE COUNCIL, INC.
Provider Business Mailing Address
First Line : 3601 16TH AVE SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-2328
Country : US
Telephone Number : 319-390-4611
Fax Number : 319-390-4381
Provider Business Practice Location Address
First Line : 3601 16TH AVE SW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52404-2328
Country : US
Telephone Number : 319-390-4611
Fax Number : 319-390-4381
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : STEPHANIE BOESENBERG
Credential :
Telephone Number : 319-390-4611
Provider Enumeration Date : 07/07/2005
Last Update Date : 05/28/2024

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