Healthcare Provider Details

I. General information

NPI: 1205746435
Provider Name (Legal Business Name): EMM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S 19TH STREET CT
MARION IA
52302-4142
US

IV. Provider business mailing address

245 S 19TH STREET CT
MARION IA
52302-4142
US

V. Phone/Fax

Practice location:
  • Phone: 319-777-1748
  • Fax:
Mailing address:
  • Phone: 319-777-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. ETHERTON MUCHIRAHONDO
Title or Position: PRESIDENT
Credential:
Phone: 319-777-1748