Healthcare Provider Details

I. General information

NPI: 1740010867
Provider Name (Legal Business Name): DELIGHT MEDICAL STAFFING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 NW 62ND AVE UNIT NW62ND
JOHNSTON IA
50131-1528
US

IV. Provider business mailing address

6000 NW 62ND AVE UNIT NW62ND
JOHNSTON IA
50131-1528
US

V. Phone/Fax

Practice location:
  • Phone: 515-306-1550
  • Fax: 515-401-0829
Mailing address:
  • Phone: 515-306-1550
  • Fax: 515-401-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MANDELA I
Title or Position: CEO
Credential: CMA
Phone: 515-306-1550