Healthcare Provider Details

I. General information

NPI: 1598974743
Provider Name (Legal Business Name): GT ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

19501 180TH STREET
PERRY IA
50220-6330
US

IV. Provider business mailing address

19501 180TH STREET
PERRY IA
50220-6330
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-2614
  • Fax: 515-465-9390
Mailing address:
  • Phone: 515-465-2614
  • Fax: 515-465-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. GREGORY DALE STEFFEN
Title or Position: OWNER
Credential: D,D,S.
Phone: 515-465-2614