Provider Demographics
NPI:1881432649
Name:MID IOWA BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:MID IOWA BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, IAADC, SAP
Authorized Official - Phone:515-571-7953
Mailing Address - Street 1:1300 37TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1900
Mailing Address - Country:US
Mailing Address - Phone:515-571-7953
Mailing Address - Fax:515-868-0306
Practice Address - Street 1:1300 37TH ST STE 4
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1900
Practice Address - Country:US
Practice Address - Phone:515-571-7953
Practice Address - Fax:515-868-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children