Healthcare Provider Details

I. General information

NPI: 1588400675
Provider Name (Legal Business Name): BAHO ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 23RD ST
WEST DES MOINES IA
50265-6225
US

IV. Provider business mailing address

7077 HICKORY LN
URBANDALE IA
50322-1892
US

V. Phone/Fax

Practice location:
  • Phone: 515-865-4754
  • Fax:
Mailing address:
  • Phone: 515-422-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON NDIKURUGAMBA
Title or Position: PRESIDENT
Credential:
Phone: 515-422-6923