Healthcare Provider Details

I. General information

NPI: 1043486400
Provider Name (Legal Business Name): ALCOHOL & DRUG DEPENDENCY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HIGHWAY 61 N
WAPELLO IA
52653-1243
US

IV. Provider business mailing address

1340 MOUNT PLEASANT ST
BURLINGTON IA
52601-2623
US

V. Phone/Fax

Practice location:
  • Phone: 319-523-8436
  • Fax: 319-523-8436
Mailing address:
  • Phone: 319-753-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. RICHARD SWANSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 319-753-6567