Provider Demographics
NPI:1104263920
Name:CLAY COUNTY CASE MANAGEMENT
Entity type:Organization
Organization Name:CLAY COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGEMENT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:712-262-9438
Mailing Address - Street 1:215 W 4TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3860
Mailing Address - Country:US
Mailing Address - Phone:712-262-9438
Mailing Address - Fax:
Practice Address - Street 1:215 W 4TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3860
Practice Address - Country:US
Practice Address - Phone:712-262-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0082966251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000082966Medicaid