Provider Demographics
NPI:1780800672
Name:DICKINSON IRON COMMUNITY SERVICES AGENCY
Entity type:Organization
Organization Name:DICKINSON IRON COMMUNITY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-774-2256
Mailing Address - Street 1:1238 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4724
Mailing Address - Country:US
Mailing Address - Phone:906-774-2256
Mailing Address - Fax:906-774-2257
Practice Address - Street 1:1238 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4724
Practice Address - Country:US
Practice Address - Phone:906-774-2256
Practice Address - Fax:906-774-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care