Provider Demographics
NPI:1659586584
Name:HUMAN SERVICES CHEROKEE
Entity Type:Organization
Organization Name:HUMAN SERVICES CHEROKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-225-1685
Mailing Address - Street 1:1251 W CEDAR LOOP
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1566
Mailing Address - Country:US
Mailing Address - Phone:712-225-2594
Mailing Address - Fax:712-225-1684
Practice Address - Street 1:1251 W CEDAR LOOP
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1566
Practice Address - Country:US
Practice Address - Phone:712-225-2594
Practice Address - Fax:712-225-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121H283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2640029Medicaid