Healthcare Provider Details

I. General information

NPI: 1902727621
Provider Name (Legal Business Name): GREENFIELD SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 146TH STREET
URBANDALE IA
50323
US

IV. Provider business mailing address

6701 CORPORATE DR STE N
JOHNSTON IA
50131-1659
US

V. Phone/Fax

Practice location:
  • Phone: 325-271-8202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GILBERT KWIHANGANA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 325-271-8202