Provider Demographics
NPI:1912952961
Name:CLARINDA ADULT PSYCH HOSP
Entity Type:Organization
Organization Name:CLARINDA ADULT PSYCH HOSP
Other - Org Name:CLARINDA TREATMENT COMPLEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-542-6107
Mailing Address - Street 1:1800 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-1165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-2161
Practice Address - Fax:712-542-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7843336C0003X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0850016Medicaid
1622554OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IA0850016Medicaid