Provider Demographics
NPI:1255399986
Name:BUENA VISTA COUNTY COMMUNITY SERVICES
Entity type:Organization
Organization Name:BUENA VISTA COUNTY COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CPC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-749-2556
Mailing Address - Street 1:541 CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588
Mailing Address - Country:US
Mailing Address - Phone:712-749-2556
Mailing Address - Fax:712-749-2707
Practice Address - Street 1:541 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588
Practice Address - Country:US
Practice Address - Phone:712-749-2556
Practice Address - Fax:712-749-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0062331Medicaid