Provider Demographics
NPI:1457990970
Name:CRUISE & NEIL
Entity Type:Organization
Organization Name:CRUISE & NEIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:319-364-8741
Mailing Address - Street 1:1221 PARK PL NE STE F
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2019
Mailing Address - Country:US
Mailing Address - Phone:319-364-8741
Mailing Address - Fax:
Practice Address - Street 1:1221 PARK PL NE STE F
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2019
Practice Address - Country:US
Practice Address - Phone:319-364-8741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1477997807Medicaid