Healthcare Provider Details

I. General information

NPI: 1023166576
Provider Name (Legal Business Name): PLYMOUTH LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PLYMOUTH ST SE
LE MARS IA
51031-3631
US

IV. Provider business mailing address

214 PLYMOUTH ST SE
LE MARS IA
51031-3631
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-6500
  • Fax: 712-546-6589
Mailing address:
  • Phone: 712-546-6500
  • Fax: 712-546-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN MARIE BRITT
Title or Position: HR MANAGER
Credential:
Phone: 712-546-6500