Provider Demographics
NPI:1538248448
Name:COUNTY OF SAC
Entity type:Organization
Organization Name:COUNTY OF SAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIIHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-662-4785
Mailing Address - Street 1:116 SOUTH STATE ST., SUITE A
Mailing Address - Street 2:COURTHOUSE ANNEX
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583
Mailing Address - Country:US
Mailing Address - Phone:712-662-4785
Mailing Address - Fax:712-662-7862
Practice Address - Street 1:116 SOUTH STATE ST., SUITE A
Practice Address - Street 2:COURTHOUSE ANNEX
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583
Practice Address - Country:US
Practice Address - Phone:712-662-4785
Practice Address - Fax:712-662-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670976Medicaid
IA0670976Medicaid