Healthcare Provider Details

I. General information

NPI: 1114906906
Provider Name (Legal Business Name): ALL CARE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S 6TH ST
COUNCIL BLUFFS IA
51501-6441
US

IV. Provider business mailing address

902 S 6TH ST
COUNCIL BLUFFS IA
51501-6441
US

V. Phone/Fax

Practice location:
  • Phone: 712-325-1990
  • Fax: 712-325-0288
Mailing address:
  • Phone: 712-325-1990
  • Fax: 712-325-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SLOBODNIK
Title or Position: ACCOUNTS REC MANAGER
Credential:
Phone: 712-325-1990