Healthcare Provider Details

I. General information

NPI: 1932084407
Provider Name (Legal Business Name): 2 LAINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 3RD ST UNIT 903
DAVENPORT IA
52801-1233
US

IV. Provider business mailing address

326 W 3RD ST UNIT 903
DAVENPORT IA
52801-1233
US

V. Phone/Fax

Practice location:
  • Phone: 563-676-9396
  • Fax:
Mailing address:
  • Phone: 563-676-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: WARNICE EDWARDS
Title or Position: ADMINISTRATOR
Credential:
Phone: 563-676-9396