Provider Demographics
NPI:1528288263
Name:ZION INTEGRATED BEHAVIORAL HEALTH SERVICES INC.
Entity type:Organization
Organization Name:ZION INTEGRATED BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HERRICK COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-243-5091
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-0034
Mailing Address - Country:US
Mailing Address - Phone:712-243-5091
Mailing Address - Fax:712-243-1337
Practice Address - Street 1:2307 OLIVE ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-9768
Practice Address - Country:US
Practice Address - Phone:712-243-5091
Practice Address - Fax:712-243-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IA1267261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA68236OtherWELLMARK BCBS
IA0177394Medicaid