Provider Demographics
NPI:1265638225
Name:WARREN COUNTY
Entity Type:Organization
Organization Name:WARREN COUNTY
Other - Org Name:WARREN COUNTY NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NUTRITION PROJECT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-1003
Mailing Address - Street 1:301 N BUXTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-1801
Mailing Address - Country:US
Mailing Address - Phone:515-961-1003
Mailing Address - Fax:515-961-1013
Practice Address - Street 1:301 N BUXTON ST STE 202
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1801
Practice Address - Country:US
Practice Address - Phone:515-961-1003
Practice Address - Fax:515-961-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0165878332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0165878Medicaid