Provider Demographics
NPI:1871705046
Name:SALVATION ARMY ADULT DAY HEALTH CENTER
Entity type:Organization
Organization Name:SALVATION ARMY ADULT DAY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-424-4031
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1646
Mailing Address - Country:US
Mailing Address - Phone:641-424-4031
Mailing Address - Fax:641-421-2019
Practice Address - Street 1:221 19TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-6655
Practice Address - Country:US
Practice Address - Phone:641-421-2577
Practice Address - Fax:641-421-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAADS502261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0489393Medicaid