Provider Demographics
NPI:1457401754
Name:GRUNDY COUNTY CASE MANAGEMENT
Entity Type:Organization
Organization Name:GRUNDY COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ALESE
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-824-6779
Mailing Address - Street 1:704 H AVE
Mailing Address - Street 2:COURTHOUSE ANNEX
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-1410
Mailing Address - Country:US
Mailing Address - Phone:319-824-6779
Mailing Address - Fax:319-824-6921
Practice Address - Street 1:704 H AVE
Practice Address - Street 2:COURTHOUSE ANNEX
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1410
Practice Address - Country:US
Practice Address - Phone:319-824-6779
Practice Address - Fax:319-824-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0108597Medicaid
IA0264887Medicaid