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NPI #1033496518 in Waterloo, Iowa

Provider Information

NPI Number
1033496518
Entity Type
Organization
Organization Name
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Primary Specialty
Intermediate Care Facility, Mental Illness
Enumeration Date
Nov 10, 2011
Last Updated
May 10, 2013

Practice Location

Address
1410 W DUNKERTON RD
State
Iowa
ZIP Code
50703-9648
Phone
(319) 291-2509

Authorized Official

Name
DOUGLAS C. MEYER
Title
PROVISIONAL ADMINISTRATOR
Phone
(319) 291-2509

Specialties & Taxonomy Codes

Specialty
Intermediate Care Facility, Mental Illness

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