Organization
STORY COUNTY COMMUNITY LIFE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAYLA R HARKEN MS (DIRECTOR)
(515) 956-2602
Entity
Organization
Contact information
Practice address
104 S HAZEL AVE, AMES, IA 50010-5952
(515) 956-2600
(515) 956-2609
Mailing address
104 S HAZEL AVE, AMES, IA 50010-5952
(515) 956-2600
(515) 956-2609
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740352467
—
IA
Enumeration date
04/14/2008
Last updated
04/14/2008
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