Provider Demographics
NPI:1164032934
Name:AWAKENING SUBSTANCE ABUSE & BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:AWAKENING SUBSTANCE ABUSE & BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMEHED
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:LISW, CADC
Authorized Official - Phone:319-351-9760
Mailing Address - Street 1:2030 KEOKUK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4456
Mailing Address - Country:US
Mailing Address - Phone:319-351-9760
Mailing Address - Fax:
Practice Address - Street 1:2030 KEOKUK ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4456
Practice Address - Country:US
Practice Address - Phone:319-351-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)