Provider Demographics
NPI:1003286683
Name:MITCHELL COUNTY
Entity Type:Organization
Organization Name:MITCHELL COUNTY
Other - Org Name:MITCHELL COUNTY HOME HEALTH CARE AND PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:641-832-3500
Mailing Address - Street 1:415 PLEASANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1935
Mailing Address - Country:US
Mailing Address - Phone:641-832-3500
Mailing Address - Fax:641-832-3501
Practice Address - Street 1:415 PLEASANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1935
Practice Address - Country:US
Practice Address - Phone:641-832-3500
Practice Address - Fax:641-832-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670422Medicaid
IA67042OtherBLUE CROSS BLUE SHEILD
IA16D0675870OtherCLIA
IA167042Medicare UPIN