Provider Demographics
NPI:1679014161
Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Other - Org Name:UNITYPOINT HEALTH-BERRYHILL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUS SERVICES MGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-574-8381
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:800-482-8305
Mailing Address - Fax:
Practice Address - Street 1:322 S 13TH ST
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-1910
Practice Address - Country:US
Practice Address - Phone:800-482-8305
Practice Address - Fax:515-573-7898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITYPOINT HEALTH-TRINITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
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
IA07466OtherWELLMARK
IA0159608Medicaid
IA0159608Medicaid