Provider Demographics
NPI:1003979485
Name:LINNHAVEN, INC
Entity Type:Organization
Organization Name:LINNHAVEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PITLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-377-9788
Mailing Address - Street 1:1199 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3013
Mailing Address - Country:US
Mailing Address - Phone:319-377-9788
Mailing Address - Fax:319-377-7641
Practice Address - Street 1:1199 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3013
Practice Address - Country:US
Practice Address - Phone:319-377-9788
Practice Address - Fax:319-377-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0260109Medicaid
IA0106526Medicaid