Provider Demographics
NPI:1235286345
Name:INDEPENDENT CASE MANAGEMENT
Entity Type:Organization
Organization Name:INDEPENDENT CASE MANAGEMENT
Other - Org Name:SOUTHEAST IOWA CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:641-472-3523
Mailing Address - Street 1:101 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-4313
Mailing Address - Country:US
Mailing Address - Phone:641-472-3523
Mailing Address - Fax:641-472-0656
Practice Address - Street 1:101 N 16TH ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-4313
Practice Address - Country:US
Practice Address - Phone:641-472-3523
Practice Address - Fax:641-472-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0741827Medicaid
IA0064519Medicaid
IA0166538Medicaid