Provider Demographics
NPI:1750511143
Name:ST GREGORY CENTERS, INC
Entity type:Organization
Organization Name:ST GREGORY CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-298-7209
Mailing Address - Street 1:601 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:IA
Mailing Address - Zip Code:50029-7722
Mailing Address - Country:US
Mailing Address - Phone:515-298-7209
Mailing Address - Fax:631-410-1394
Practice Address - Street 1:5875 FLEUR DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-2883
Practice Address - Country:US
Practice Address - Phone:515-298-7209
Practice Address - Fax:631-410-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1332324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility