Healthcare Provider Details

I. General information

NPI: 1497536569
Provider Name (Legal Business Name): RISE AND SHINE RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 146TH ST
URBANDALE IA
50323-2800
US

IV. Provider business mailing address

5419 146TH ST
URBANDALE IA
50323-2800
US

V. Phone/Fax

Practice location:
  • Phone: 701-320-4871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS CHIMANGA
Title or Position: PRESIDENT
Credential:
Phone: 701-320-4871