Provider Demographics
NPI:1205911765
Name:MENTAL HEALTH INSTITUTE
Entity type:Organization
Organization Name:MENTAL HEALTH INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDANT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHASKER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-334-2583
Mailing Address - Street 1:2277 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9106
Mailing Address - Country:US
Mailing Address - Phone:319-334-2583
Mailing Address - Fax:319-334-5252
Practice Address - Street 1:2277 IOWA AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9106
Practice Address - Country:US
Practice Address - Phone:319-334-2583
Practice Address - Fax:319-334-5252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10PM35323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0010108Medicaid