Provider Demographics
NPI:1134263056
Name:LINN COUNTY MHDD SERVICES
Entity type:Organization
Organization Name:LINN COUNTY MHDD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LINN COUNTY CPC
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-892-5620
Mailing Address - Street 1:305 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1215
Mailing Address - Country:US
Mailing Address - Phone:319-892-5620
Mailing Address - Fax:319-892-5677
Practice Address - Street 1:305 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1215
Practice Address - Country:US
Practice Address - Phone:319-892-5620
Practice Address - Fax:319-892-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739433Medicaid