Healthcare Provider Details

I. General information

NPI: 1871847202
Provider Name (Legal Business Name): ILLUMINATIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 GRAND AVE STE 104
AMES IA
50010-6061
US

IV. Provider business mailing address

515 GRAND AVE STE 104
AMES IA
50010-6061
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-7157
  • Fax: 515-232-7116
Mailing address:
  • Phone: 515-232-7157
  • Fax: 515-232-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number01108
License Number StateIA

VIII. Authorized Official

Name: DEBORAH CARNINE
Title or Position: OWNER
Credential: L.I.S.W.
Phone: 515-232-7157