Provider Demographics
NPI:1659590594
Name:BOONE COUNTY RECOVERY CENTER
Entity Type:Organization
Organization Name:BOONE COUNTY RECOVERY CENTER
Other - Org Name:BOONE COUNTY COMMUNITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-432-7995
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4821
Mailing Address - Country:US
Mailing Address - Phone:515-432-7995
Mailing Address - Fax:515-432-4213
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-432-7995
Practice Address - Fax:515-432-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherLEVEL 1 SUBSTANCE ABUSE