Provider Demographics
NPI:1992353411
Name:AMERISERVE INTERNATIONAL II, INC.
Entity type:Organization
Organization Name:AMERISERVE INTERNATIONAL II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:712-322-0272
Mailing Address - Street 1:35 MAIN PL STE 300
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0702
Mailing Address - Country:US
Mailing Address - Phone:712-322-0272
Mailing Address - Fax:
Practice Address - Street 1:35 MAIN PL STE 300
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0702
Practice Address - Country:US
Practice Address - Phone:712-322-0272
Practice Address - Fax:712-322-0272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERISERVE INTERNATIONAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA203641Medicaid