Healthcare Provider Details

I. General information

NPI: 1255868360
Provider Name (Legal Business Name): ON WITH LIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 NW 43RD AVE
DES MOINES IA
50313
US

IV. Provider business mailing address

715 SW ANKENY RD
ANKENY IA
50023-9798
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-6860
  • Fax: 515-289-1492
Mailing address:
  • Phone: 515-289-9658
  • Fax: 515-965-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA EWALD
Title or Position: OFFICE MANAGER
Credential:
Phone: 515-289-9658