Provider Demographics
NPI:1578634143
Name:NORTH IOWA TRANSITION CENTER
Entity Type:Organization
Organization Name:NORTH IOWA TRANSITION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEILE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-424-8708
Mailing Address - Street 1:PO BOX 1503
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1503
Mailing Address - Country:US
Mailing Address - Phone:641-424-8708
Mailing Address - Fax:641-421-7809
Practice Address - Street 1:408 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3004
Practice Address - Country:US
Practice Address - Phone:641-424-8708
Practice Address - Fax:641-421-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1229377Medicaid
IA0229377Medicaid
IA1737874Medicaid
IA0739417Medicaid