| Sogc Inc | |
|
14542 61st Ave. Blue Grass IA 52726-9592 | |
| (563) 381-4649 | |
| (563) 381-4649 |
| Full Name | Sogc Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14542 61st Ave., Blue Grass, Iowa |
| Authorized Official Name and Position | Susan Lee Potthast (DIRECTOR OF THERAPEUTIC SERVICES) |
| Authorized Official Contact | 5633814649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sogc Inc 14542 61st Ave. Blue Grass IA 52726-9592 Ph: (563) 381-4649 | Sogc Inc 14542 61st Ave. Blue Grass IA 52726-9592 Ph: (563) 381-4649 |
| NPI Number | 1619155504 |
|---|---|
| Provider Enumeration Date | 02/04/2008 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619155504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |