Healthcare Provider Details

I. General information

NPI: 1013067800
Provider Name (Legal Business Name): DALLAS COUNTY CARE FACILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25747 N AVE
ADEL IA
50003-8277
US

IV. Provider business mailing address

25747 N AVE
ADEL IA
50003-8277
US

V. Phone/Fax

Practice location:
  • Phone: 515-993-4721
  • Fax: 515-993-5832
Mailing address:
  • Phone: 515-993-4721
  • Fax: 515-993-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0469783
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRIS BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-993-4721