Healthcare Provider Details

I. General information

NPI: 1225991912
Provider Name (Legal Business Name): COMFORT RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5919 NW 50TH ST
JOHNSTON IA
50131-4760
US

IV. Provider business mailing address

5919 NW 50TH ST
JOHNSTON IA
50131-4760
US

V. Phone/Fax

Practice location:
  • Phone: 207-409-2798
  • Fax:
Mailing address:
  • Phone:
  • 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: DOMINIQUE MAZAMBO
Title or Position: CEO
Credential:
Phone: 207-409-2798