Healthcare Provider Details

I. General information

NPI: 1295642502
Provider Name (Legal Business Name): STELLA'S HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18063 TANGLEWOOD DR
CLIVE IA
50325-2595
US

IV. Provider business mailing address

18063 TANGLEWOOD DR
CLIVE IA
50325-2595
US

V. Phone/Fax

Practice location:
  • Phone: 515-216-8095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JERRICA AMERISON-SMITH
Title or Position: OWNER/CEO
Credential:
Phone: 515-216-8095