Healthcare Provider Details

I. General information

NPI: 1245364082
Provider Name (Legal Business Name): POLK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 EUCLID AVE
DES MOINES IA
50310-5703
US

IV. Provider business mailing address

2309 EUCLID AVE
DES MOINES IA
50310-5703
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-4545
  • Fax: 515-243-8447
Mailing address:
  • Phone: 515-243-4545
  • Fax: 515-243-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LYNN FERRELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-243-4545