Provider Demographics
NPI:1740414671
Name:FAMILY BEHAVIORAL HEALTHCARE OF IOWA
Entity Type:Organization
Organization Name:FAMILY BEHAVIORAL HEALTHCARE OF IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WOODS
Authorized Official - Last Name:WEINAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-752-7300
Mailing Address - Street 1:218 N 3RD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5330
Mailing Address - Country:US
Mailing Address - Phone:319-752-7300
Mailing Address - Fax:
Practice Address - Street 1:218 N 3RD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5330
Practice Address - Country:US
Practice Address - Phone:319-752-7300
Practice Address - Fax:319-752-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00683251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1497797591OtherNPI INDIVIDUAL NUMBER