Provider Demographics
NPI:1124097134
Name:COMMUNITY MENTAL HEALTH CENTER FOR MID-EASTERN IOWA
Entity type:Organization
Organization Name:COMMUNITY MENTAL HEALTH CENTER FOR MID-EASTERN IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREFZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-338-7884
Mailing Address - Street 1:507 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-5115
Mailing Address - Country:US
Mailing Address - Phone:319-338-7884
Mailing Address - Fax:319-338-7006
Practice Address - Street 1:507 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-5115
Practice Address - Country:US
Practice Address - Phone:319-338-7884
Practice Address - Fax:319-338-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN/A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074591Medicaid
IA0074591Medicaid