Northland Agency on Aging

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

NORTHLAND AGENCY ON AGING

Practice address

808 River St
Decorah, IA 52101-2134

Phone

(563) 382-2941

Fax

(563) 382-6248

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Bruce A. Butters

Title

Executive Director

Phone

(563) 382-2941

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962620195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 RIVER ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012134",
            "telephone_number": "563-382-2941",
            "fax_number": "563-382-6248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 RIVER ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012134",
            "telephone_number": "563-382-2941",
            "fax_number": "563-382-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND AGENCY ON AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUTTERS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "563-382-2941",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105890",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.