Provider Demographics
NPI:1205990223
Name:THE LARRABEE CENTER, IN.C
Entity type:Organization
Organization Name:THE LARRABEE CENTER, IN.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHARM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-2234
Mailing Address - Street 1:117 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2212
Mailing Address - Country:US
Mailing Address - Phone:319-352-2234
Mailing Address - Fax:
Practice Address - Street 1:117 11TH ST NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2212
Practice Address - Country:US
Practice Address - Phone:319-352-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0163428Medicaid
IA0225987Medicaid
IA1225987Medicaid
IA0746859Medicaid