Provider Demographics
NPI:1013152776
Name:DES MOINES VALLEY HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:DES MOINES VALLEY HEALTH AND HUMAN SERVICES
Other - Org Name:JACKSON COUNTY HUMAN SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIR OF BUSINESS OPER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-831-1891
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-9998
Mailing Address - Country:US
Mailing Address - Phone:507-831-1891
Mailing Address - Fax:507-831-0126
Practice Address - Street 1:407 5TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-9588
Practice Address - Country:US
Practice Address - Phone:507-847-4000
Practice Address - Fax:507-847-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA000032900OtherUMPI
MN000032900Medicaid
MNA000032900Medicare UPIN