Provider Demographics
NPI:1508048992
Name:HOWARD COUNTY CASE MANAGEMENT
Entity Type:Organization
Organization Name:HOWARD COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPILDE
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:563-547-3966
Mailing Address - Street 1:205 2ND ST E
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1602
Mailing Address - Country:US
Mailing Address - Phone:563-547-3966
Mailing Address - Fax:563-547-3117
Practice Address - Street 1:205 2ND ST E
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1602
Practice Address - Country:US
Practice Address - Phone:563-547-3966
Practice Address - Fax:563-547-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
IA252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0288829Medicaid
IA0111658Medicaid