Provider Demographics
NPI:1578781654
Name:CERRO GORDO COUNTY CASE MANAGEMENT
Entity Type:Organization
Organization Name:CERRO GORDO COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:641-421-3122
Mailing Address - Street 1:220 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-3220
Mailing Address - Country:US
Mailing Address - Phone:641-421-3122
Mailing Address - Fax:641-421-3132
Practice Address - Street 1:3 4TH ST NE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-7001
Practice Address - Country:US
Practice Address - Phone:641-421-3122
Practice Address - Fax:641-421-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0054726Medicaid
IA0741231Medicaid