Provider Demographics
NPI:1265103220
Name:MIDWEST BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MIDWEST BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:RALYNN
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:515-724-9896
Mailing Address - Street 1:102 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2126
Mailing Address - Country:US
Mailing Address - Phone:515-386-2433
Mailing Address - Fax:515-386-2124
Practice Address - Street 1:102 N WILSON STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129
Practice Address - Country:US
Practice Address - Phone:515-386-2433
Practice Address - Fax:515-386-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1444OtherIOWA DEPARTMENT OF PUBLIC HEALTH