Organization
DEPARTMENT OF HUMAN SERVICES GLENWOOD RESOURCE CENTER
Active
Other names
Family Support & Outreach Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RANDI R CLOYED (TREATMENT SERVICE DIRECTOR)
(712) 525-1395
Entity
Organization
Contact information
Practice address
711 S VINE ST, GLENWOOD, IA 51534-1927
(712) 527-4811
(712) 525-1405
Mailing address
711 S VINE ST, GLENWOOD, IA 51534-1927
(712) 527-4811
(712) 525-1405
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136952
WAIVER
IA
Enumeration date
01/03/2007
Last updated
08/28/2008
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