Provider Demographics
NPI: | 1437359726 |
---|---|
Name: | SYSTEMS UNLIMITED, INC. |
Entity Type: | Organization |
Organization Name: | SYSTEMS UNLIMITED, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVR DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GORMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 319-338-9212 |
Mailing Address - Street 1: | 2533 SCOTT BLVD SE |
Mailing Address - Street 2: | |
Mailing Address - City: | IOWA CITY |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52240-8195 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-338-9212 |
Mailing Address - Fax: | 319-337-9073 |
Practice Address - Street 1: | 2533 SCOTT BLVD SE |
Practice Address - Street 2: | |
Practice Address - City: | IOWA CITY |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52240-8195 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-338-9212 |
Practice Address - Fax: | 319-337-9073 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-24 |
Last Update Date: | 2007-07-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IA | 0760777 | Medicaid |