Healthcare Provider Details

I. General information

NPI: 1841279239
Provider Name (Legal Business Name): MENTAL HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

IV. Provider business mailing address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-2583
  • Fax: 319-334-5252
Mailing address:
  • Phone: 319-334-2583
  • Fax: 319-334-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number100068H
License Number StateIA

VIII. Authorized Official

Name: DR. BHASKER DAVE
Title or Position: SUPERINTENDANT
Credential: M.D.
Phone: 319-334-2583