Provider Demographics
NPI:1871665372
Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:PO BOX 1C
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-3001
Mailing Address - Country:US
Mailing Address - Phone:402-527-2049
Mailing Address - Fax:
Practice Address - Street 1:359 INDIAN HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1953
Practice Address - Country:US
Practice Address - Phone:712-527-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65PM28323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0010090Medicaid