Provider Demographics
NPI:1962480962
Name:COUNTY OF LOUISA
Entity Type:Organization
Organization Name:COUNTY OF LOUISA
Other - Org Name:LOUISA COUNTY PUBLIC HEALTH NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-523-3981
Mailing Address - Street 1:805 JL HODGES AVE.
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653
Mailing Address - Country:US
Mailing Address - Phone:319-523-3981
Mailing Address - Fax:319-523-8408
Practice Address - Street 1:12635 COUNTY ROAD G56 STE 103
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-9564
Practice Address - Country:US
Practice Address - Phone:319-523-3981
Practice Address - Fax:319-523-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1962480962251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67050OtherWELLMARK BC/BS PROVIDER #
IA0670505Medicaid
IA167050Medicare ID - Type UnspecifiedPROVIDER NUMBER