Provider Demographics
NPI:1174991053
Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Entity type:Organization
Organization Name:NORTH CENTRAL IOWA MENTAL HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-482-8305
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:800-482-8305
Mailing Address - Fax:515-573-7898
Practice Address - Street 1:1525 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3027
Practice Address - Country:US
Practice Address - Phone:800-482-8305
Practice Address - Fax:515-573-7898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-09
Last Update Date:2018-11-30
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
IA0159608Medicaid
IA0159608Medicaid