| Young House Family Services, Incorporated | |
|
4717 Sullivan Slough Rd Burlington IA 52601-9013 | |
| (319) 758-4000 | |
| (319) 752-6933 |
| Full Name | Young House Family Services, Incorporated |
|---|---|
| Speciality | Social Worker |
| Location | 4717 Sullivan Slough Rd, Burlington, Iowa |
| Authorized Official Name and Position | Melissa Brown (CONTROLLER) |
| Authorized Official Contact | 3197524000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Young House Family Services, Incorporated 4717 Sullivan Slough Rd Burlington IA 52601-9013 Ph: (319) 758-4000 | Young House Family Services, Incorporated 4717 Sullivan Slough Rd Burlington IA 52601-9013 Ph: (319) 758-4000 |
| NPI Number | 1194864090 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 04/11/2024 |
| Certification Date | 04/11/2024 |
| Medicare PECOS PAC ID | 4981125911 |
|---|---|
| Medicare Enrollment ID | O20250306003322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194864090 | NPI | - | NPPES |
| 1102046 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 1102046 (Iowa) | Primary |
| Provider Name | Steven Bantz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720578982 PECOS PAC ID: 4284155136 Enrollment ID: I20250307000602 |
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