Healthcare Provider Details

I. General information

NPI: 1093647992
Provider Name (Legal Business Name): FARAJA HOST HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E SAN MARNAN DR
WATERLOO IA
50702-5607
US

IV. Provider business mailing address

707 E SAN MARNAN DR
WATERLOO IA
50702-5607
US

V. Phone/Fax

Practice location:
  • Phone: 319-212-8935
  • Fax: 319-212-8935
Mailing address:
  • Phone: 319-212-8935
  • Fax: 319-212-8935

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: SHABANI E MUBIBYA
Title or Position: CEO
Credential: MUBIBYA
Phone: 319-212-8935