Provider Demographics
NPI:1114958535
Name:COUNTY OF BREMER
Entity Type:Organization
Organization Name:COUNTY OF BREMER
Other - Org Name:BREMER COUNTY COMMUNITY BASED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-2990
Mailing Address - Street 1:112 10TH STREET S.W.
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677
Mailing Address - Country:US
Mailing Address - Phone:319-352-2990
Mailing Address - Fax:319-352-2979
Practice Address - Street 1:112 10TH STREET S.W.
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677
Practice Address - Country:US
Practice Address - Phone:319-352-2990
Practice Address - Fax:319-352-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1229096Medicaid
IA0229096Medicaid
IA0136275Medicaid