Healthcare Provider Details

I. General information

NPI: 1962480962
Provider Name (Legal Business Name): COUNTY OF LOUISA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12635 COUNTY ROAD G56 STE 103
WAPELLO IA
52653-9564
US

IV. Provider business mailing address

805 JL HODGES AVE.
WAPELLO IA
52653
US

V. Phone/Fax

Practice location:
  • Phone: 319-523-3981
  • Fax: 319-523-8408
Mailing address:
  • Phone: 319-523-3981
  • Fax: 319-523-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1962480962
License Number StateIA

VIII. Authorized Official

Name: BRANDY SMITH
Title or Position: MANAGER
Credential:
Phone: 319-523-3981