Provider Demographics
NPI:1316029705
Name:WEST CENTRAL MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WEST CENTRAL MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUCKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:515-993-4535
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-0007
Mailing Address - Country:US
Mailing Address - Phone:515-993-4535
Mailing Address - Fax:515-993-3845
Practice Address - Street 1:2111 W GREEN ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1637
Practice Address - Country:US
Practice Address - Phone:515-993-4535
Practice Address - Fax:515-993-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074476Medicaid
IA0742825Medicaid
IA0074476Medicaid
IA27730Medicare PIN
IA07447Medicare PIN