Healthcare Provider Details

I. General information

NPI: 1750661179
Provider Name (Legal Business Name): CDAC SERVICES OF IOWA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14586 SCOTCH RIDGE RD
CARLISLE IA
50047-3131
US

IV. Provider business mailing address

14586 SCOTCH RIDGE RD P.O. BOX 426
CARLISLE IA
50047-3131
US

V. Phone/Fax

Practice location:
  • Phone: 515-953-2755
  • Fax:
Mailing address:
  • Phone: 515-953-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN H JUDISCH
Title or Position: PRESIDENT / OWNER
Credential: J.D.
Phone: 515-953-2755