Provider Demographics
NPI:1700953874
Name:NORTHEAST IOWA COMMUNITY ACTION CORPORATION
Entity Type:Organization
Organization Name:NORTHEAST IOWA COMMUNITY ACTION CORPORATION
Other - Org Name:NEICAC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-382-8436
Mailing Address - Street 1:305 MONTGOMERY ST
Mailing Address - Street 2:PO BOX 487
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2721
Mailing Address - Country:US
Mailing Address - Phone:563-382-8436
Mailing Address - Fax:563-382-5140
Practice Address - Street 1:305 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2721
Practice Address - Country:US
Practice Address - Phone:563-382-8436
Practice Address - Fax:563-382-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0163949Medicaid