Healthcare Provider Details

I. General information

NPI: 1679338511
Provider Name (Legal Business Name): NEZIA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 BOULDER DR
WEST DES MOINES IA
50265-4154
US

IV. Provider business mailing address

2917 BOULDER DR
WEST DES MOINES IA
50265-4154
US

V. Phone/Fax

Practice location:
  • Phone: 515-421-6509
  • Fax:
Mailing address:
  • Phone: 515-421-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BOSE PATRICK
Title or Position: MEMBER
Credential:
Phone: 515-421-6509