Provider Demographics
NPI:1093791758
Name:COUNTY OF WINNESHIEK
Entity Type:Organization
Organization Name:COUNTY OF WINNESHIEK
Other - Org Name:WINNESHIEK COUNTY PUBLIC HEALTH NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEN BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA
Authorized Official - Phone:563-382-4662
Mailing Address - Street 1:305 MONTGOMERY ST
Mailing Address - Street 2:SUITE3
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2721
Mailing Address - Country:US
Mailing Address - Phone:563-382-4662
Mailing Address - Fax:563-387-4121
Practice Address - Street 1:305 MONTGOMERY ST
Practice Address - Street 2:SUITE3
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2721
Practice Address - Country:US
Practice Address - Phone:563-382-4662
Practice Address - Fax:563-387-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670398Medicaid
IA67039OtherBLUE CROSS/BLUE SHIELD
IA0670398Medicaid