Provider Demographics
NPI:1528003670
Name:SOUTHERN IA HOME HEALTH CARE
Entity Type:Organization
Organization Name:SOUTHERN IA HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N./ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-932-7521
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-0262
Mailing Address - Country:US
Mailing Address - Phone:641-932-7521
Mailing Address - Fax:641-932-7463
Practice Address - Street 1:121 BENTON AVE W
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-1925
Practice Address - Country:US
Practice Address - Phone:641-932-7521
Practice Address - Fax:641-932-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67401OtherWELLMARK BLUE CROSS/SHIEL
IA0674010Medicaid
IA67401OtherWELLMARK BLUE CROSS/SHIEL