| NPI | 1871641159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARV FANGMAN Executive Director 515-994-3562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: IA 1234) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-08-22 |