Provider Demographics
NPI:1023166576
Name:PLYMOUTH LIFE, INC.
Entity type:Organization
Organization Name:PLYMOUTH LIFE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-546-6500
Mailing Address - Street 1:214 PLYMOUTH ST SE
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3631
Mailing Address - Country:US
Mailing Address - Phone:712-546-6500
Mailing Address - Fax:712-546-6589
Practice Address - Street 1:214 PLYMOUTH ST SE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3631
Practice Address - Country:US
Practice Address - Phone:712-546-6500
Practice Address - Fax:712-546-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0764415Medicaid
IA0108423Medicaid
IA0245100Medicaid
IA0232041Medicaid
IA0741983Medicaid
IA0242990Medicaid
IA0251561Medicaid
IA0769471Medicaid
IA0741983Medicaid
IA0232041Medicaid
IA0108423Medicaid