Healthcare Provider Details

I. General information

NPI: 1225942741
Provider Name (Legal Business Name): MAISONWELL LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 URBANDALE AVE STE 3
DES MOINES IA
50310-1271
US

IV. Provider business mailing address

5731 URBANDALE AVE STE 3
DES MOINES IA
50310-1271
US

V. Phone/Fax

Practice location:
  • Phone: 609-287-0169
  • Fax:
Mailing address:
  • Phone: 609-287-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEHINDE EMMANUEL YUSUF
Title or Position: CEO
Credential:
Phone: 609-287-0169