Provider Demographics
NPI:1851415947
Name:YOUTH HOMES OF MID-AMERICA
Entity Type:Organization
Organization Name:YOUTH HOMES OF MID-AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:515-276-3473
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-0039
Mailing Address - Country:US
Mailing Address - Phone:515-276-3473
Mailing Address - Fax:515-278-4329
Practice Address - Street 1:7225 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1948
Practice Address - Country:US
Practice Address - Phone:515-276-3473
Practice Address - Fax:515-278-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X, 261QR0400X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1102020Medicaid
IA0470195Medicaid
IA0102020Medicaid