Provider Demographics
NPI:1285764175
Name:DECATUR COUNTY COMMUNITY SERVICES
Entity type:Organization
Organization Name:DECATUR COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-446-7178
Mailing Address - Street 1:201 NE IDAHO
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144
Mailing Address - Country:US
Mailing Address - Phone:641-446-7178
Mailing Address - Fax:641-446-8208
Practice Address - Street 1:201 NE IDAHO
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144
Practice Address - Country:US
Practice Address - Phone:641-446-7178
Practice Address - Fax:641-446-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0738831251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0738831Medicaid