Provider Demographics
NPI:1629293527
Name:MARION COUNTY CARE FACILITY
Entity Type:Organization
Organization Name:MARION COUNTY CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-828-0622
Mailing Address - Street 1:1111 NEWBOLD ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-8605
Mailing Address - Country:US
Mailing Address - Phone:641-828-0622
Mailing Address - Fax:641-828-0622
Practice Address - Street 1:1111 NEWBOLD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-8605
Practice Address - Country:US
Practice Address - Phone:641-828-0622
Practice Address - Fax:641-828-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA630531320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities