Healthcare Provider Details

I. General information

NPI: 1710344098
Provider Name (Legal Business Name): CARLENROSE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 2ND ST
OTTUMWA IA
52501-2312
US

IV. Provider business mailing address

655 W 2ND ST
OTTUMWA IA
52501-2312
US

V. Phone/Fax

Practice location:
  • Phone: 641-684-4604
  • Fax: 641-683-7772
Mailing address:
  • Phone: 641-684-4604
  • Fax: 641-683-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA ROSE HULEN
Title or Position: PRESIDENT
Credential:
Phone: 641-684-4604