Provider Demographics
NPI:1215067848
Name:CHRISTIAN HOME ASSOCIATION-CHILDREN'S SQUARE U.S.A.
Entity type:Organization
Organization Name:CHRISTIAN HOME ASSOCIATION-CHILDREN'S SQUARE U.S.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-322-3700
Mailing Address - Street 1:P.O. BOX 8-C
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-3008
Mailing Address - Country:US
Mailing Address - Phone:712-322-3700
Mailing Address - Fax:712-323-6968
Practice Address - Street 1:NORTH 6TH & AVE E
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51502-3008
Practice Address - Country:US
Practice Address - Phone:712-322-3700
Practice Address - Fax:712-323-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0470971Medicaid