Healthcare Provider Details

I. General information

NPI: 1124345970
Provider Name (Legal Business Name): MAYOR'S YOUTH EMPOWERMENT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 HIGHLAND CT.
IOWA CITY IA
52240-0112
US

IV. Provider business mailing address

407 HIGHLAND CT.
IOWA CITY IA
52240-0112
US

V. Phone/Fax

Practice location:
  • Phone: 319-341-0060
  • Fax: 888-883-1235
Mailing address:
  • Phone: 319-341-0060
  • Fax: 888-883-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA SCHAA
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 319-341-0060