Provider Demographics
NPI:1457178428
Name:SOUTHERN IOWA MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:SOUTHERN IOWA MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-814-8730
Mailing Address - Street 1:1527 ALBIA RD
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3907
Mailing Address - Country:US
Mailing Address - Phone:641-682-8772
Mailing Address - Fax:641-682-1924
Practice Address - Street 1:1527 ALBIA RD
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3907
Practice Address - Country:US
Practice Address - Phone:641-682-8772
Practice Address - Fax:641-682-1924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN IOWA MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health