Provider Demographics
NPI:1184789638
Name:GREEN VALLEY AEA 14
Entity type:Organization
Organization Name:GREEN VALLEY AEA 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-782-8443
Mailing Address - Street 1:1405 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1160
Mailing Address - Country:US
Mailing Address - Phone:641-782-8443
Mailing Address - Fax:641-782-4298
Practice Address - Street 1:1405 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1160
Practice Address - Country:US
Practice Address - Phone:641-782-8443
Practice Address - Fax:641-782-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0257253Medicaid