Organization
PREMIER PAYEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNON DEANN STEWART (VICE PRESIDENT)
(641) 947-4061
Entity
Organization
Contact information
Practice address
279 PERRY ST, LACONA, IA 50139-8535
(641) 947-4061
Mailing address
279 PERRY ST, LACONA, IA 50139-8535
(641) 947-4061
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/22/2012
Last updated
06/27/2012
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