Healthcare Provider Details

I. General information

NPI: 1114853694
Provider Name (Legal Business Name): SANDRA MACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 AVENUE Q
CARTER LAKE IA
51510-1139
US

IV. Provider business mailing address

3201 RENNER DR APT K6
COUNCIL BLUFFS IA
51501-7802
US

V. Phone/Fax

Practice location:
  • Phone: 402-320-2852
  • Fax:
Mailing address:
  • Phone: 402-207-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: