Provider Demographics
NPI:1629386206
Name:ABBE CENTER FOR CMH @ GOOD SAM NURSING HOME
Entity Type:Organization
Organization Name:ABBE CENTER FOR CMH @ GOOD SAM NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAESTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-398-3562
Mailing Address - Street 1:201 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1006
Mailing Address - Country:US
Mailing Address - Phone:563-422-5344
Mailing Address - Fax:563-422-5368
Practice Address - Street 1:520 11TH ST NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-3811
Practice Address - Country:US
Practice Address - Phone:319-398-3562
Practice Address - Fax:319-398-3501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABBE CENTER FOR COMMUNITY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074575Medicaid