Organization
BLACK HAWK-GRUNDY MENTAL HEALTH CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS CHARLES EACHUS LISW (EXECUTIVE DIRECTOR)
(319) 234-2893
Entity
Organization
Contact information
Practice address
3251 W 9TH ST, WATERLOO, IA 50702-5310
(319) 234-2893
(319) 234-0354
Mailing address
3251 W 9TH ST, WATERLOO, IA 50702-5310
(319) 234-2893
(319) 234-0354
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074435
—
IA
Enumeration date
07/05/2005
Last updated
06/19/2017
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