Provider Demographics
NPI:1619026143
Name:HUBBARD RADCLIFFE
Entity type:Organization
Organization Name:HUBBARD RADCLIFFE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-864-2211
Mailing Address - Street 1:200 E CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:IA
Mailing Address - Zip Code:50122-0129
Mailing Address - Country:US
Mailing Address - Phone:641-864-2211
Mailing Address - Fax:641-864-2422
Practice Address - Street 1:200 E CHESTNUT
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:IA
Practice Address - Zip Code:50122-0129
Practice Address - Country:US
Practice Address - Phone:641-864-2211
Practice Address - Fax:641-864-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0426619Medicaid