Provider Demographics
NPI:1366570673
Name:SYSTEMS UNLIMITED, INC.
Entity type:Organization
Organization Name:SYSTEMS UNLIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN GAVRILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-338-9212
Mailing Address - Street 1:2533 SCOTT BOULEVARD SE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2533 SCOTT BOULEVARD SE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-338-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYSTEMS UNLIMITED, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0742932Medicaid