Provider Demographics
NPI:1750414405
Name:ADEL DESOTO MINBURN CSD
Entity type:Organization
Organization Name:ADEL DESOTO MINBURN CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCADON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-993-4283
Mailing Address - Street 1:801 NILE KINNICK DR S
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-2024
Mailing Address - Country:US
Mailing Address - Phone:515-993-4283
Mailing Address - Fax:515-993-4866
Practice Address - Street 1:801 NILE KINNICK DR S
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-2024
Practice Address - Country:US
Practice Address - Phone:515-993-4283
Practice Address - Fax:515-993-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32942193251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0737940Medicaid