Healthcare Provider Details

I. General information

NPI: 1861317661
Provider Name (Legal Business Name): BUILDING MOMENTUM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 252ND ST
DE WITT IA
52742-9176
US

IV. Provider business mailing address

2654 252ND ST
DE WITT IA
52742-9176
US

V. Phone/Fax

Practice location:
  • Phone: 563-349-0985
  • Fax: 563-204-3112
Mailing address:
  • Phone: 563-349-0985
  • Fax: 563-204-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LUCAS JAMES SMITH
Title or Position: CEO
Credential:
Phone: 563-349-0985