Provider Demographics
NPI:1124397781
Name:NORTH CENTRAL HOME CARE
Entity type:Organization
Organization Name:NORTH CENTRAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-573-8147
Mailing Address - Street 1:328 S 8TH ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4660
Mailing Address - Country:US
Mailing Address - Phone:515-573-8147
Mailing Address - Fax:515-955-8729
Practice Address - Street 1:328 S 8TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4660
Practice Address - Country:US
Practice Address - Phone:515-573-8147
Practice Address - Fax:515-955-8729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000135673Medicaid