Provider Demographics
NPI:1588992994
Name:DHS-TARGETED CASE MANAGEMENT
Entity type:Organization
Organization Name:DHS-TARGETED CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUREAU CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-281-7156
Mailing Address - Street 1:400 SW 8TH ST
Mailing Address - Street 2:SUITE Q
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4619
Mailing Address - Country:US
Mailing Address - Phone:515-281-7775
Mailing Address - Fax:515-281-3234
Practice Address - Street 1:400 SW 8TH ST
Practice Address - Street 2:SUITE Q
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4619
Practice Address - Country:US
Practice Address - Phone:515-281-7775
Practice Address - Fax:515-281-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1054007Medicaid
IA2054007Medicaid
IA4054007Medicaid
IA5054007Medicaid
IA3054007Medicaid
IA743096OtherMAGELLAN BEHAVIORAL CARE OF IOWA
IA6054007Medicaid
IA8054007Medicaid