Provider Demographics
NPI:1003967365
Name:CHICKASAW-MITCHELL COUNTY CASE MANAGEMENT
Entity Type:Organization
Organization Name:CHICKASAW-MITCHELL COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBLISKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-394-3426
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-0229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 N CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1349
Practice Address - Country:US
Practice Address - Phone:641-394-3426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0062976Medicaid
IA0440461Medicaid
IA283868000Medicaid