Healthcare Provider Details

I. General information

NPI: 1629316062
Provider Name (Legal Business Name): SHELTER HOUSE COMMUNITY SHELTER AND TRANSITION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 SOUTHGATE AVE
IOWA CITY IA
52240
US

IV. Provider business mailing address

PO BOX 3146
IOWA CITY IA
52244-3146
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-5416
  • Fax: 319-358-7132
Mailing address:
  • Phone: 319-338-5416
  • Fax: 319-358-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ERIN SULLIVAN
Title or Position: MENTAL HEALTH RECOVERY MANAGER
Credential:
Phone: 319-338-5416