Healthcare Provider Details

I. General information

NPI: 1760296933
Provider Name (Legal Business Name): CHRISTIAN CHURCH HOMES OF IOWA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 E. 25TH ST.
DES MOINES IA
50317-3665
US

IV. Provider business mailing address

3330 E. 25TH ST.
DES MOINES IA
50317-3665
US

V. Phone/Fax

Practice location:
  • Phone: 515-265-2172
  • Fax: 515-265-1078
Mailing address:
  • Phone: 515-265-2172
  • Fax: 515-265-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: BRENDA JANE MADDISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 515-265-2172