Provider Demographics
NPI:1558429357
Name:CRITTENTON HEALTH SERVICES
Entity Type:Organization
Organization Name:CRITTENTON HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-255-4321
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0295
Mailing Address - Country:US
Mailing Address - Phone:712-255-4321
Mailing Address - Fax:712-252-4743
Practice Address - Street 1:303 W 24TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-4025
Practice Address - Country:US
Practice Address - Phone:712-255-4321
Practice Address - Fax:712-252-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025473200Medicaid
NE10025473100Medicaid
IA0497610Medicaid