Provider Demographics
NPI:1063848711
Name:SUBSTANCE ABUSE SERVICES CENTER
Entity Type:Organization
Organization Name:SUBSTANCE ABUSE SERVICES CENTER
Other - Org Name:SASC - CEDAR RAPIDS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-927-5112
Mailing Address - Street 1:799 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6844
Mailing Address - Country:US
Mailing Address - Phone:319-582-3784
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE
Practice Address - Street 2:SUITE 307
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3200
Practice Address - Country:US
Practice Address - Phone:319-294-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1216251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health