Provider Demographics
NPI:1659561819
Name:JASPER COUNTY ELDERLY NUTRITION
Entity Type:Organization
Organization Name:JASPER COUNTY ELDERLY NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-792-7102
Mailing Address - Street 1:2401 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-4252
Mailing Address - Country:US
Mailing Address - Phone:641-792-7102
Mailing Address - Fax:641-791-9976
Practice Address - Street 1:2401 1ST AVE E # STAVEE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4252
Practice Address - Country:US
Practice Address - Phone:641-792-7102
Practice Address - Fax:641-791-9976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASPER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0134189332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0134189Medicaid