Healthcare Provider Details

I. General information

NPI: 1295654903
Provider Name (Legal Business Name): WANAS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LOCUST ST
DES MOINES IA
50309-4104
US

IV. Provider business mailing address

500 LOCUST ST
DES MOINES IA
50309-4104
US

V. Phone/Fax

Practice location:
  • Phone: 646-544-6156
  • Fax:
Mailing address:
  • Phone: 646-544-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOKUBE FRITZ
Title or Position: OWNER
Credential: M.S., CYBERSECURITY
Phone: 646-544-6156