Organization
INFINITY HEALTH
Active
Other names
Behavioral Health Centers of SO IA - Centerville
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMANTHA CANNON (CEO)
(641) 446-2383
Entity
Organization
Contact information
Practice address
221 E STATE ST, CENTERVILLE, IA 52544-1813
(641) 856-6471
(641) 856-2603
Mailing address
302 NE 14TH ST, LEON, IA 50144-1206
(641) 446-2383
(641) 446-2382
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
IA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0763805
—
IA
01
—
39014
WELLMARK BLUE CROSS/BLUE SHIELD
—
05
—
507402808
—
MO
Enumeration date
04/13/2007
Last updated
02/11/2022
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