Basic Information
| Provider Information | |||||||||
| NPI: | 1942613955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR BEHAVIORAL HEALTH IOWA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 897 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837010897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083679021 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3811 N HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528065911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083679446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | MASSMAN | ||||||||
| AuthorizedOfficialFirstName: | BRANT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2083679446 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.