Provider Demographics
NPI:1689762882
Name:SOUTHWEST IOWA FAMILIES INC
Entity Type:Organization
Organization Name:SOUTHWEST IOWA FAMILIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNEETA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAGONER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-542-3501
Mailing Address - Street 1:215 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1625
Mailing Address - Country:US
Mailing Address - Phone:712-542-3501
Mailing Address - Fax:712-542-4725
Practice Address - Street 1:215 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1625
Practice Address - Country:US
Practice Address - Phone:712-542-3501
Practice Address - Fax:712-542-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-12-18
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
NE10025357200OtherNE MEDICAID
IAI10860Medicare PIN