Provider Demographics
NPI:1225406481
Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Other - Org Name:UNITYPOINT HEALTH- BERRYHILL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-955-7171
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-955-7171
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:301 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-2411
Practice Address - Country:US
Practice Address - Phone:800-482-8305
Practice Address - Fax:515-573-7898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITYPOINT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
07466Medicare PIN