Provider Demographics
NPI:1265582589
Name:FREMONT COUNTY COMMUNITY SERVICES
Entity type:Organization
Organization Name:FREMONT COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC & CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:712-374-3075
Mailing Address - Street 1:414 CLAY
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:SIDNEY
Mailing Address - State:IA
Mailing Address - Zip Code:51652-0540
Mailing Address - Country:US
Mailing Address - Phone:712-374-3075
Mailing Address - Fax:712-374-6119
Practice Address - Street 1:414 CLAY
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:IA
Practice Address - Zip Code:51652
Practice Address - Country:US
Practice Address - Phone:712-374-3075
Practice Address - Fax:712-374-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0189654Medicaid
IA0190793Medicaid