Provider Demographics
NPI:1093818189
Name:COUNTY OF POCAHONTAS
Entity Type:Organization
Organization Name:COUNTY OF POCAHONTAS
Other - Org Name:POCAHONTAS COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-335-4142
Mailing Address - Street 1:99 COURT SQUARE
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1629
Mailing Address - Country:US
Mailing Address - Phone:712-335-4142
Mailing Address - Fax:712-335-3581
Practice Address - Street 1:99 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1629
Practice Address - Country:US
Practice Address - Phone:712-335-4142
Practice Address - Fax:712-335-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670968Medicaid
IA0670968Medicaid