Provider Demographics
NPI:1235135666
Name:COUNTY OF OBRIEN
Entity Type:Organization
Organization Name:COUNTY OF OBRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:YOUNGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:712-957-0105
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245
Mailing Address - Country:US
Mailing Address - Phone:712-957-0105
Mailing Address - Fax:712-957-0105
Practice Address - Street 1:155 S HAYES AVENUE
Practice Address - Street 2:
Practice Address - City:PRIMGHAR
Practice Address - State:IA
Practice Address - Zip Code:51245
Practice Address - Country:US
Practice Address - Phone:712-957-0105
Practice Address - Fax:712-957-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2013-08-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-01
Provider Licenses
StateLicense IDTaxonomies
IAA128751251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10656Medicare ID - Type Unspecified