Mid Iowa Behavioral Services

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

MID IOWA BEHAVIORAL SERVICES

Practice address

1300 37TH St Ste 4
West Des Moines, IA 50266-1900

Phone

(515) 571-7953

Fax

(515) 868-0306

NPI assigned

Jul 16, 2024

Last updated

Jul 16, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert E. Thacker, MA, IAADC, SAP

Title

Owner/Executive Director

Phone

(515) 571-7953

Specialties & licenses 5

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1881432649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 37TH ST STE 4",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661900",
            "telephone_number": "515-571-7953",
            "fax_number": "515-868-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 37TH ST STE 4",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502661900",
            "telephone_number": "515-571-7953",
            "fax_number": "515-868-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID IOWA BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "515-571-7953",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, IAADC, SAP"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.