Provider Demographics
NPI:1083791396
Name:CENTERVILLE COMMUNITY BETTERMENT INC ZYLPHA PRICE HOUSE
Entity Type:Organization
Organization Name:CENTERVILLE COMMUNITY BETTERMENT INC ZYLPHA PRICE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-437-1051
Mailing Address - Street 1:1111 N HAYNES AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1133
Mailing Address - Country:US
Mailing Address - Phone:641-437-1051
Mailing Address - Fax:641-437-1404
Practice Address - Street 1:1111 N HAYNES AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1133
Practice Address - Country:US
Practice Address - Phone:641-437-1051
Practice Address - Fax:641-437-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0131276251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0131276Medicaid