Healthcare Provider Details

I. General information

NPI: 1629973607
Provider Name (Legal Business Name): DES MOINES OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1251 KEOSAUQUA WAY
DES MOINES IA
50309-1013
US

IV. Provider business mailing address

1251 KEOSAUQUA WAY
DES MOINES IA
50309-1013
US

V. Phone/Fax

Practice location:
  • Phone: 515-220-8344
  • Fax:
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 StateNULL

VIII. Authorized Official

Name: DARCY BRAZZLE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 484-888-1200