Healthcare Provider Details

I. General information

NPI: 1548179906
Provider Name (Legal Business Name): UBUMWE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 SE 14TH ST
GRIMES IA
50111-2309
US

IV. Provider business mailing address

624 SE 14TH ST
GRIMES IA
50111-2309
US

V. Phone/Fax

Practice location:
  • Phone: 515-414-4387
  • Fax:
Mailing address:
  • Phone: 515-414-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIE MUTESI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 515-414-4387