Provider Demographics
NPI:1144256272
Name:COUNTY COMMUNITY SERVICES
Entity type:Organization
Organization Name:COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-433-0593
Mailing Address - Street 1:900 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-3914
Mailing Address - Country:US
Mailing Address - Phone:515-433-0593
Mailing Address - Fax:515-432-2480
Practice Address - Street 1:900 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-3914
Practice Address - Country:US
Practice Address - Phone:515-433-0593
Practice Address - Fax:515-432-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0490656Medicaid
IA0490664Medicaid