Provider Demographics
NPI:1356643647
Name:BETHANY CHRISTIAN SERVICES OF SOUTH CENTRAL IOWA
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF SOUTH CENTRAL IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/BRANCH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBMA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-729-3112
Mailing Address - Street 1:316 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1907
Mailing Address - Country:US
Mailing Address - Phone:515-270-0824
Mailing Address - Fax:515-270-0605
Practice Address - Street 1:316 E 6TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1907
Practice Address - Country:US
Practice Address - Phone:515-270-0824
Practice Address - Fax:515-270-0605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES OF SOUTH CENTRAL IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00802OtherTHERAPY WITH CHILDREN WITH COMPLEX TRAUMA/THERAPY WITH WOMEN