Provider Demographics
NPI:1043486400
Name:ALCOHOL & DRUG DEPENDENCY SERVICES
Entity Type:Organization
Organization Name:ALCOHOL & DRUG DEPENDENCY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-753-6567
Mailing Address - Street 1:1340 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-2623
Mailing Address - Country:US
Mailing Address - Phone:319-753-6567
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1243
Practice Address - Country:US
Practice Address - Phone:319-523-8436
Practice Address - Fax:319-523-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility