Provider Demographics
NPI:1538500566
Name:HEALING HARVEST MINISTRIES, INC.
Entity Type:Organization
Organization Name:HEALING HARVEST MINISTRIES, INC.
Other - Org Name:SPECIAL NEEDS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-3966
Mailing Address - Street 1:PO BOX 4117
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-4117
Mailing Address - Country:US
Mailing Address - Phone:319-277-3966
Mailing Address - Fax:
Practice Address - Street 1:669 S HACKETT RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5632
Practice Address - Country:US
Practice Address - Phone:319-277-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000205220Medicaid