Provider Demographics
NPI:1467401356
Name:NORTHWEST IOWA MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHWEST IOWA MENTAL HEALTH CENTER
Other - Org Name:OAK HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-2922
Mailing Address - Street 1:2273 170TH ST
Mailing Address - Street 2:
Mailing Address - City:OKOBOJI
Mailing Address - State:IA
Mailing Address - Zip Code:51355-2529
Mailing Address - Country:US
Mailing Address - Phone:712-332-2932
Mailing Address - Fax:712-332-2783
Practice Address - Street 1:2273 170TH ST
Practice Address - Street 2:
Practice Address - City:OKOBOJI
Practice Address - State:IA
Practice Address - Zip Code:51355-2529
Practice Address - Country:US
Practice Address - Phone:712-332-2932
Practice Address - Fax:712-332-2783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST IOWA MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0894733Medicaid