Provider Demographics
NPI:1700910866
Name:CARROLL COUNTY HOME CARE AIDE SERVICE
Entity Type:Organization
Organization Name:CARROLL COUNTY HOME CARE AIDE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN CARROLL COUNTY BOARD OF HE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETERS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-792-1500
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-0966
Mailing Address - Country:US
Mailing Address - Phone:712-792-9517
Mailing Address - Fax:712-792-0254
Practice Address - Street 1:17436 MAHOGANY AVENUE
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-0966
Practice Address - Country:US
Practice Address - Phone:712-792-9517
Practice Address - Fax:712-792-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0138875Medicaid