Provider Demographics
NPI:1205845856
Name:CENTERVILLE CSD
Entity Type:Organization
Organization Name:CENTERVILLE CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-856-0603
Mailing Address - Street 1:634 N MAIN ST
Mailing Address - Street 2:PO BOX 370
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1414
Mailing Address - Country:US
Mailing Address - Phone:641-856-0603
Mailing Address - Fax:641-856-0656
Practice Address - Street 1:634 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1414
Practice Address - Country:US
Practice Address - Phone:641-856-0603
Practice Address - Fax:641-856-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269464Medicaid