Healthcare Provider Details

I. General information

NPI: 1326489907
Provider Name (Legal Business Name): ALEXANDER ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N JEFFERSON ST
OTTUMWA IA
52501-2021
US

IV. Provider business mailing address

RR 1 BOX 83H
MEMPHIS MO
63555-9644
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-5437
  • Fax:
Mailing address:
  • Phone: 641-777-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04839
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number04839
License Number StateIA

VIII. Authorized Official

Name: JOY ALEXANDER
Title or Position: VICE PRESIDENT
Credential: MSW, LISW, LCSW
Phone: 641-777-1842