Healthcare Provider Details

I. General information

NPI: 1417200155
Provider Name (Legal Business Name): HOUSE OF MERCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
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

2009 NW ASHLAND PKWY
ANKENY IA
50023-8754
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-6500
  • Fax: 505-643-6532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALMEDINA ISLAMOVIC
Title or Position: RESIDENT COUNSELOR
Credential: B.A
Phone: 515-643-6500