Provider Demographics
NPI:1164402293
Name:SUBSTANCE ABUSE SERVICES CENTER
Entity Type:Organization
Organization Name:SUBSTANCE ABUSE SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-927-5112
Mailing Address - Street 1:799 MAIN ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6844
Mailing Address - Country:US
Mailing Address - Phone:563-582-3784
Mailing Address - Fax:563-582-4006
Practice Address - Street 1:799 MAIN ST
Practice Address - Street 2:SUITE 270
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6844
Practice Address - Country:US
Practice Address - Phone:563-582-3784
Practice Address - Fax:563-582-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA680204OtherWELLMARK BC/BS
IN0177394Medicaid
IA=========OtherCOMMERCIAL