Provider Demographics
NPI:1629316062
Name:SHELTER HOUSE COMMUNITY SHELTER AND TRANSITION SERVICES
Entity Type:Organization
Organization Name:SHELTER HOUSE COMMUNITY SHELTER AND TRANSITION SERVICES
Other - Org Name:SHELTER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH RECOVERY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-338-5416
Mailing Address - Street 1:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-3146
Mailing Address - Country:US
Mailing Address - Phone:319-338-5416
Mailing Address - Fax:319-358-7132
Practice Address - Street 1:429 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-338-5416
Practice Address - Fax:319-358-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 253Z00000X
IA385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000110127Medicaid
IAX000158000Medicaid