Provider Demographics
NPI:1497959050
Name:MIDWEST CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:MIDWEST CHRISTIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:712-295-7601
Mailing Address - Street 1:4509 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSON
Mailing Address - State:IA
Mailing Address - Zip Code:51047-7524
Mailing Address - Country:US
Mailing Address - Phone:712-295-7601
Mailing Address - Fax:712-295-7600
Practice Address - Street 1:4509 20TH AVE
Practice Address - Street 2:
Practice Address - City:PETERSON
Practice Address - State:IA
Practice Address - Zip Code:51047-7524
Practice Address - Country:US
Practice Address - Phone:712-295-7601
Practice Address - Fax:712-295-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29-11-001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children