Provider Demographics
NPI:1285798488
Name:MOC-FLOYD VALLEY CSD
Entity type:Organization
Organization Name:MOC-FLOYD VALLEY CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-737-4873
Mailing Address - Street 1:1301 8TH ST SE
Mailing Address - Street 2:P.O. BOX 257
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-7472
Mailing Address - Country:US
Mailing Address - Phone:712-737-4873
Mailing Address - Fax:712-737-8987
Practice Address - Street 1:1301 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-7472
Practice Address - Country:US
Practice Address - Phone:712-737-4873
Practice Address - Fax:712-737-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0417014Medicaid