Provider Demographics
NPI:1336350339
Name:SAC COUNTY
Entity Type:Organization
Organization Name:SAC COUNTY
Other - Org Name:SAC IDA CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VILLHAUER-MURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-662-7998
Mailing Address - Street 1:1710 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-1012
Mailing Address - Country:US
Mailing Address - Phone:712-662-7998
Mailing Address - Fax:712-662-7762
Practice Address - Street 1:1710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-1012
Practice Address - Country:US
Practice Address - Phone:712-662-7998
Practice Address - Fax:712-662-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0760132Medicaid