Healthcare Provider Details

I. General information

NPI: 1649392325
Provider Name (Legal Business Name): HOUSE OF MERCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 CLARK ST
DES MOINES IA
50314-1964
US

IV. Provider business mailing address

1409 CLARK ST
DES MOINES IA
50314-1964
US

V. Phone/Fax

Practice location:
  • Phone: 515-515-6434
  • Fax:
Mailing address:
  • Phone: 515-515-6434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD BEVERIDGE
Title or Position: DIRECTOR
Credential: DIRECTOR
Phone: 515-247-3265