Provider Demographics
NPI:1053467159
Name:SUPPORT SERVICES OF SOUTH CENTRAL IOWA
Entity Type:Organization
Organization Name:SUPPORT SERVICES OF SOUTH CENTRAL IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-782-8495
Mailing Address - Street 1:306 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-1257
Mailing Address - Country:US
Mailing Address - Phone:641-743-0063
Mailing Address - Fax:641-743-0904
Practice Address - Street 1:306 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-1257
Practice Address - Country:US
Practice Address - Phone:641-743-0063
Practice Address - Fax:641-743-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0219832Medicaid