Organization
HANDICAP VILLAGE
Active
Other names
Opportunity Village
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SEVERTSON (CEO)
(641) 357-5277
Entity
Organization
Contact information
Practice address
1470 21ST AVE N, FORT DODGE, IA 50501-7114
(515) 573-8243
(515) 576-4269
Mailing address
PO BOX 622, CLEAR LAKE, IA 50428-0622
(641) 357-5277
(641) 357-6471
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
11/06/2009
Last updated
11/06/2009
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