Healthcare Provider Details

I. General information

NPI: 1558430686
Provider Name (Legal Business Name): COMMUNITY SUPPORT ADVOCATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 AURORA AVE. SUITE B
DES MOINES IA
50322
US

IV. Provider business mailing address

6000 AURORA AVE. SUITE B
DES MOINES IA
50322
US

V. Phone/Fax

Practice location:
  • Phone: 515-883-1776
  • Fax: 515-883-2171
Mailing address:
  • Phone: 515-883-1776
  • Fax: 515-883-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. CHRISTINA LYNN SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-883-1776