Healthcare Provider Details

I. General information

NPI: 1689707622
Provider Name (Legal Business Name): QUAKERDALE FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 240TH ST
MARSHALLTOWN IA
50158-8984
US

IV. Provider business mailing address

2932 240TH ST
MARSHALLTOWN IA
50158-8984
US

V. Phone/Fax

Practice location:
  • Phone: 641-752-3912
  • Fax: 641-752-3639
Mailing address:
  • Phone: 641-752-3912
  • Fax: 641-752-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETH ANN ANDREW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 641-752-3912