Healthcare Provider Details

I. General information

NPI: 1871705046
Provider Name (Legal Business Name): SALVATION ARMY ADULT DAY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 19TH ST SW SUITE B
MASON CITY IA
50401-6655
US

IV. Provider business mailing address

PO BOX 1646
MASON CITY IA
50402-1646
US

V. Phone/Fax

Practice location:
  • Phone: 641-421-2577
  • Fax: 641-421-2580
Mailing address:
  • Phone: 641-424-4031
  • Fax: 641-421-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAADS502
License Number StateIA

VIII. Authorized Official

Name: CHUCK WRIGHT
Title or Position: CORP OFFICER
Credential:
Phone: 641-424-4031