Provider Demographics
NPI:1154129054
Name:INDEPENDENT WAIVERS SERVICES OF WEST CENTRAL IOWA LLC
Entity type:Organization
Organization Name:INDEPENDENT WAIVERS SERVICES OF WEST CENTRAL IOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUELTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-269-8388
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:BREDA
Mailing Address - State:IA
Mailing Address - Zip Code:51436-0345
Mailing Address - Country:US
Mailing Address - Phone:712-269-8388
Mailing Address - Fax:
Practice Address - Street 1:403 BRUNING ST
Practice Address - Street 2:
Practice Address - City:BREDA
Practice Address - State:IA
Practice Address - Zip Code:51436-7725
Practice Address - Country:US
Practice Address - Phone:712-269-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000720189Medicaid