Provider Demographics
NPI:1922795541
Name:SUMMIT BHC IOWA, LLC
Entity Type:Organization
Organization Name:SUMMIT BHC IOWA, LLC
Other - Org Name:IVORY PLAINS RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:MANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-637-7157
Mailing Address - Street 1:389 NICHOL MILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4887
Mailing Address - Country:US
Mailing Address - Phone:615-478-7796
Mailing Address - Fax:
Practice Address - Street 1:608 NORTH ST
Practice Address - Street 2:
Practice Address - City:ADAIR
Practice Address - State:IA
Practice Address - Zip Code:50002-1126
Practice Address - Country:US
Practice Address - Phone:615-637-7157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. GREGORY RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit