Provider Demographics
NPI:1811187917
Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-955-7171
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:515-955-7171
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:726 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5344
Practice Address - Country:US
Practice Address - Phone:515-955-7171
Practice Address - Fax:515-573-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
IA07466OtherWELLMARK BC/BS
IA0159608Medicaid