Healthcare Provider Details

I. General information

NPI: 1225290299
Provider Name (Legal Business Name): EMBRACE LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 UNIVERSITY BLVD SUITE 121
AMES IA
50010-8629
US

IV. Provider business mailing address

2521 UNIVERSITY BLVD SUITE 121
AMES IA
50010-8629
US

V. Phone/Fax

Practice location:
  • Phone: 515-291-1499
  • Fax: 515-292-2184
Mailing address:
  • Phone: 515-291-1499
  • Fax: 515-292-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06044
License Number StateIA

VIII. Authorized Official

Name: CATHY S NELSON
Title or Position: CO-DIRECTOR/OWNER
Credential: LISW
Phone: 515-291-1499