Provider Demographics
NPI:1356414239
Name:RINGGOLD COUNTY GROUP HOME
Entity type:Organization
Organization Name:RINGGOLD COUNTY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:QMRP
Authorized Official - Phone:641-464-2871
Mailing Address - Street 1:111 RINGGOLD STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854
Mailing Address - Country:US
Mailing Address - Phone:641-464-2871
Mailing Address - Fax:
Practice Address - Street 1:111 RINGGOLD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-1215
Practice Address - Country:US
Practice Address - Phone:641-464-2871
Practice Address - Fax:641-464-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities