Provider Demographics
NPI:1295886232
Name:SOUTHWEST IOWA CASE MANAGEMENT
Entity type:Organization
Organization Name:SOUTHWEST IOWA CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-2983
Mailing Address - Street 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2141
Mailing Address - Country:US
Mailing Address - Phone:712-542-2983
Mailing Address - Fax:712-542-2370
Practice Address - Street 1:112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2141
Practice Address - Country:US
Practice Address - Phone:712-542-2983
Practice Address - Fax:712-542-2370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAGE COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251C00000X
IAIAC- CHAPTER 24251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0153502Medicaid
IA0746545Medicaid
IA0162321Medicaid