Provider Demographics
NPI:1144307059
Name:JACKSON COUNTY CASE MANAGEMENT
Entity type:Organization
Organization Name:JACKSON COUNTY CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-652-4246
Mailing Address - Street 1:201 W PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2243
Mailing Address - Country:US
Mailing Address - Phone:563-652-4246
Mailing Address - Fax:563-652-0337
Practice Address - Street 1:201 W PLATT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2243
Practice Address - Country:US
Practice Address - Phone:563-652-4246
Practice Address - Fax:563-652-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0121772Medicaid
IA0121772MMedicaid
IA0206219Medicaid