Provider Demographics
NPI:1992886881
Name:MAINSTREAM LIVING, INC.
Entity type:Organization
Organization Name:MAINSTREAM LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZELLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-232-8405
Mailing Address - Street 1:2012 E 13TH ST
Mailing Address - Street 2:BOX 1608
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5601
Mailing Address - Country:US
Mailing Address - Phone:515-232-8405
Mailing Address - Fax:515-232-8448
Practice Address - Street 1:2012 E 13TH ST
Practice Address - Street 2:BOX 1608
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5601
Practice Address - Country:US
Practice Address - Phone:515-232-8405
Practice Address - Fax:515-232-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0226878Medicaid
IA0896613Medicaid
IA1226878Medicaid
IA0095323Medicaid