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General NPI Number Information
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NPI Number | 1033379565
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Entity Type | Organization
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Legal Business Name | REGIONAL ENTERPRISES INC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 312 E ALTA VISTA AVE
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City | OTTUMWA
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State | IA
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Zip | 52501-1413
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Country | US
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Telephone | 641-682-7511
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Fax | 641-683-2862
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Provider Business Mailing Address
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Address Line | 1001 PENNSYLVANIA AVE
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City | OTTUMWA
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State | IA
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Zip | 52501-6427
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Country | US
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Telephone | 641-682-7511
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Fax | 641-683-2862
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Authorized Official
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Title or Position | CEO
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Name | MR. THOMAS SIEMERS
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Credential |
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Telephone | 641-682-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1265
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License Number State | IA
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