Provider Demographics
NPI:1689669459
Name:NORTHWEST IOWA MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHWEST IOWA MENTAL HEALTH CENTER
Other - Org Name:SEASONS CENTER FOR BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-2922
Mailing Address - Street 1:201 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4436
Mailing Address - Country:US
Mailing Address - Phone:712-262-2922
Mailing Address - Fax:712-262-3826
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4436
Practice Address - Country:US
Practice Address - Phone:712-262-2922
Practice Address - Fax:712-262-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2013-04-09
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
IA0011650Medicaid
001165Medicare Oscar/Certification
IA0011650Medicaid
01165Medicare PIN