Provider Demographics
NPI:1053536961
Name:CLARKE COUNTY HOMEMAKERS
Entity type:Organization
Organization Name:CLARKE COUNTY HOMEMAKERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-342-3133
Mailing Address - Street 1:800 S FILLMORE ST
Mailing Address - Street 2:P. O. BOX 384
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1619
Mailing Address - Country:US
Mailing Address - Phone:641-342-3133
Mailing Address - Fax:641-342-2835
Practice Address - Street 1:800 S FILLMORE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1619
Practice Address - Country:US
Practice Address - Phone:641-342-3133
Practice Address - Fax:641-342-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101386Medicaid