Provider Demographics
NPI:1104973148
Name:RABINER TREATMENT CENTER
Entity type:Organization
Organization Name:RABINER TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DAUN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-573-1396
Mailing Address - Street 1:1762 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8408
Mailing Address - Country:US
Mailing Address - Phone:515-576-7388
Mailing Address - Fax:515-576-2239
Practice Address - Street 1:1762 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-8408
Practice Address - Country:US
Practice Address - Phone:515-573-8444
Practice Address - Fax:515-573-8442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA11836Medicaid