Healthcare Provider Details

I. General information

NPI: 1114075561
Provider Name (Legal Business Name): YOUTH EMERGENCY SERVICES & SHELTER OF IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SE 11TH ST
DES MOINES IA
50309-5324
US

IV. Provider business mailing address

918 SE 11TH ST
DES MOINES IA
50309-5324
US

V. Phone/Fax

Practice location:
  • Phone: 515-243-7825
  • Fax: 515-282-6162
Mailing address:
  • Phone: 515-243-7825
  • Fax: 515-282-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. STEPHEN B QUIRK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-243-7825