Organization
GRACE C MAE ADVOCATE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA C GILBAUGH LISW, PHD (EXECUTIVE DIRECTOR/THERAPIST)
(319) 361-6529
Entity
Organization
Contact information
Practice address
420 E POLK ST, WASHINGTON, IA 52353-1237
(319) 653-3930
Mailing address
PO BOX 4, VAN HORNE, IA 52346-0004
(319) 361-6529
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
008087
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101342
—
IA
Enumeration date
05/29/2013
Last updated
05/29/2013
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