Healthcare Provider Details

I. General information

NPI: 1902726474
Provider Name (Legal Business Name): FILE:///C:/USERS/ALHADMIN/APPDATA/LOCAL/TEMP/
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 HARRISON AVE
DES MOINES IA
50314-2337
US

IV. Provider business mailing address

1338 HARRISON AVE
DES MOINES IA
50314-2337
US

V. Phone/Fax

Practice location:
  • Phone: 515-633-7663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AHMED ABDIRAHMAN
Title or Position: CO-OWNER
Credential:
Phone: 515-633-7663