Healthcare Provider Details

I. General information

NPI: 1710046255
Provider Name (Legal Business Name): FOUR OAKS FAMILY AND CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 KIRKWOOD BLVD SW
CEDAR RAPIDS IA
52404-5216
US

IV. Provider business mailing address

5400 KIRKWOOD BLVD SW SOUTH VILLAGE
CEDAR RAPIDS IA
52404-5216
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-0259
  • Fax: 866-290-5565
Mailing address:
  • Phone: 319-364-0259
  • Fax: 866-290-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY BETH O'NEILL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 319-364-0259