Provider Demographics
NPI:1265646392
Name:SCENIC ACRES
Entity Type:Organization
Organization Name:SCENIC ACRES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SEIFERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-245-2640
Mailing Address - Street 1:23105 GRANITE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAINT OLAF
Mailing Address - State:IA
Mailing Address - Zip Code:52072-8049
Mailing Address - Country:US
Mailing Address - Phone:563-245-2640
Mailing Address - Fax:563-245-1945
Practice Address - Street 1:23105 GRANITE AVENUE
Practice Address - Street 2:
Practice Address - City:SAINT OLAF
Practice Address - State:IA
Practice Address - Zip Code:52072-8049
Practice Address - Country:US
Practice Address - Phone:563-245-2640
Practice Address - Fax:563-245-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0430454320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0430454Medicaid