Provider Demographics
NPI:1831434109
Name:HFS ASBURY WEST CMHC
Entity type:Organization
Organization Name:HFS ASBURY WEST CMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-583-7357
Mailing Address - Street 1:2728 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2971
Mailing Address - Country:US
Mailing Address - Phone:563-875-0769
Mailing Address - Fax:
Practice Address - Street 1:2728 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2971
Practice Address - Country:US
Practice Address - Phone:563-875-0769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLCREST FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
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
IA0488775Medicaid
ID11492OtherBCBS
IA0488775Medicaid