Healthcare Provider Details

I. General information

NPI: 1891090502
Provider Name (Legal Business Name): MENTAL MISSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 FOREST CT
WINDSOR HEIGHTS IA
50324-1330
US

IV. Provider business mailing address

7200 FOREST CT
WINDSOR HEIGHTS IA
50324-1330
US

V. Phone/Fax

Practice location:
  • Phone: 515-274-8720
  • Fax:
Mailing address:
  • Phone: 515-274-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BYRON CRUMP JARRETT SR.
Title or Position: CEO
Credential:
Phone: 515-274-8720