Provider Demographics
NPI:1255543898
Name:BREMER COUNTY CASE MANAGEMENT
Entity type:Organization
Organization Name:BREMER COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-1919
Mailing Address - Street 1:203 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-1703
Mailing Address - Country:US
Mailing Address - Phone:319-352-1919
Mailing Address - Fax:319-352-2997
Practice Address - Street 1:203 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-1703
Practice Address - Country:US
Practice Address - Phone:319-352-1919
Practice Address - Fax:319-352-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0749184Medicaid