Organization
SOUTHWEST IOWA FAMILIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BERNEETA L WAGONER LISW (AGENCY DIRECTOR)
(712) 542-3501
Entity
Organization
Contact information
Practice address
215 E WASHINGTON ST, CLARINDA, IA 51632-1625
(712) 542-3501
(712) 542-4725
Mailing address
215 E WASHINGTON ST, CLARINDA, IA 51632-1625
(712) 542-3501
(712) 542-4725
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
01
—
10025357200
NE MEDICAID
NE
Enumeration date
10/11/2006
Last updated
12/18/2007
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