MEDICARE: MARION COUNTY ELDERLY NUTRITION

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
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1932462496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION COUNTY ELDERLY NUTRITION

Provider Business Mailing Address
First Line	:	308 E MONTGOMERY ST
Second Line	:
City	:	KNOXVILLE
State	:	IA
Zip	:	50138-2242
Country	:	US
Telephone Number	:	641-842-6070
Fax Number	:	641-828-2173

Provider Business Practice Location Address
First Line	:	308 E MONTGOMERY ST
Second Line	:
City	:	KNOXVILLE
State	:	IA
Zip	:	50138-2242
Country	:	US
Telephone Number	:	641-842-6070
Fax Number	:	641-828-2173

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	MS. DAWN MARIE ALLSPACH
Credential	:
Telephone Number	:	641-842-6070

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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