Provider Demographics
NPI:1699757294
Name:COUNTY OF CHEROKEE
Entity type:Organization
Organization Name:COUNTY OF CHEROKEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:712-225-6718
Mailing Address - Street 1:520 W MAIN ST
Mailing Address - Street 2:BOX B
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1700
Mailing Address - Country:US
Mailing Address - Phone:712-225-6718
Mailing Address - Fax:712-225-6710
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:BOX B
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1700
Practice Address - Country:US
Practice Address - Phone:712-225-6718
Practice Address - Fax:712-225-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67072OtherBLUE CROSS-BLUE SHIELD
IA0670729Medicaid
IA0670729Medicaid