Provider Demographics
NPI:1174976757
Name:NORTH IOWA JUVENILE DETENTION SERVICES
Entity type:Organization
Organization Name:NORTH IOWA JUVENILE DETENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LACINA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, MSN, APMHNP
Authorized Official - Phone:319-291-2455
Mailing Address - Street 1:1440 W DUNKERTON RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-9648
Mailing Address - Country:US
Mailing Address - Phone:319-291-2455
Mailing Address - Fax:319-291-2464
Practice Address - Street 1:1440 W DUNKERTON RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-9648
Practice Address - Country:US
Practice Address - Phone:319-291-2455
Practice Address - Fax:319-291-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility