Organization
CHRISTIAN HOME ASSOCIATION-CHILDREN'S SQUARE U.S.A.
Active
Other names
CHILDREN'S SQUARE U.S.A.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK J DUMAN (CHIEF FINANCIAL OFFICER)
(712) 322-3700
Entity
Organization
Contact information
Practice address
NORTH 6TH & AVE E, COUNCIL BLUFFS, IA 51502-3008
(712) 322-3700
(712) 323-6968
Mailing address
PO BOX 8C, COUNCIL BLUFFS, IA 51502-3008
(712) 322-3700
(712) 323-6968
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
2084P0800X
Psychiatry Physician
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071605
—
IA
Enumeration date
01/29/2007
Last updated
01/27/2022
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