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General NPI Number Information
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NPI Number | 1053635292
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Entity Type | Organization
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Legal Business Name | FAMILY DIRECTIONS OF IOWA
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 1211 VINE ST SUITE 2140
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City | WEST DES MOINES
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State | IA
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Zip | 50265-4472
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Country | US
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Telephone | 515-255-9490
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Fax | 515-279-5163
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Provider Business Mailing Address
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Address Line | 1211 VINE ST SUITE 2140
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City | WEST DES MOINES
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State | IA
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Zip | 50265-4472
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Country | US
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Telephone | 515-255-9490
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Fax | 515-279-5163
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SUZANNE J RENFROW
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Credential | LBSW
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Telephone | 515-255-9490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 04652
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License Number State | IA
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