Provider Demographics
NPI:1184605826
Name:CLARINDA MENTAL HEALTH INSTITUTE
Entity type:Organization
Organization Name:CLARINDA MENTAL HEALTH INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-2161
Mailing Address - Street 1:1800 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1165
Mailing Address - Country:US
Mailing Address - Phone:712-542-2161
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA730132H283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA064858000OtherMAGELLAN BEHAVIORAL HEALT
IA0850016Medicaid
IA2640052Medicaid
IA30820OtherMEDICARE PART B
IA64005OtherWELLMARK BLUE CROSS
IA064858000OtherMAGELLAN BEHAVIORAL HEALT
IA=========01Medicaid