Provider Demographics
NPI:1548219074
Name:DALLAS COUNTY
Entity Type:Organization
Organization Name:DALLAS COUNTY
Other - Org Name:TRI-COUNTY CASE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-993-1736
Mailing Address - Street 1:902 COURT ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:515-993-5872
Practice Address - Street 1:902 COURT ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1448
Practice Address - Country:US
Practice Address - Phone:515-993-1736
Practice Address - Fax:515-993-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0061952Medicaid
IA0158600Medicaid