Healthcare Provider Details

I. General information

NPI: 1144178799
Provider Name (Legal Business Name): SUPPORTIVE HOME & COMMUNITY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5062 GRANDVIEW AVE
DES MOINES IA
50317-6048
US

IV. Provider business mailing address

5062 GRANDVIEW AVE
DES MOINES IA
50317-6048
US

V. Phone/Fax

Practice location:
  • Phone: 515-500-8050
  • Fax:
Mailing address:
  • Phone: 804-616-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ARNEAU MICHEL LEMOUPA FOKOU
Title or Position: CEO/OWNER
Credential:
Phone: 804-616-1707