Provider Demographics
NPI:1003978297
Name:REM IOWA DEVELOPMENTAL SERVICES, INC.
Entity type:Organization
Organization Name:REM IOWA DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & SR. ASST GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:1220 INDUSTRIAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-1118
Mailing Address - Country:US
Mailing Address - Phone:319-393-1944
Mailing Address - Fax:319-393-2091
Practice Address - Street 1:1395 STAMY RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-9500
Practice Address - Country:US
Practice Address - Phone:319-378-9333
Practice Address - Fax:319-393-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0445445Medicaid
IA0709511Medicaid