Provider Demographics
NPI:1548404445
Name:BETHANY CHRISTIAN SERVICES OF NORTHWEST IOWA
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF NORTHWEST IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCORZA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMSW
Authorized Official - Phone:712-737-4831
Mailing Address - Street 1:123 ALBANY AVE SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1715
Mailing Address - Country:US
Mailing Address - Phone:712-737-4831
Mailing Address - Fax:712-737-3238
Practice Address - Street 1:123 ALBANY AVE SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1715
Practice Address - Country:US
Practice Address - Phone:712-737-4831
Practice Address - Fax:712-737-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X
NE35396374251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1639372642OtherBLUE-CROSS BLUE SHIELD
IA1639372642Medicaid
IA1639372642OtherMIDLANDS CHOICE