Healthcare Provider Details

I. General information

NPI: 1619806106
Provider Name (Legal Business Name): EMINENT GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 DAKOTA CIR
WAUKEE IA
50263-7125
US

IV. Provider business mailing address

160 DAKOTA CIR
WAUKEE IA
50263-7125
US

V. Phone/Fax

Practice location:
  • Phone: 515-200-9559
  • Fax:
Mailing address:
  • Phone: 515-200-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CYRUS B GUEH SR.
Title or Position: CEO
Credential:
Phone: 515-200-9559