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General NPI Number Information
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NPI Number | 1083016174
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Entity Type | Organization
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Legal Business Name | STILL WATER HOME CARE
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 1414 E 9TH ST
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City | DES MOINES
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State | IA
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Zip | 50316-2261
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Country | US
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Telephone | 515-441-0708
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 E 9TH ST
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City | DES MOINES
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State | IA
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Zip | 50316-2261
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Country | US
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Telephone | 515-441-0708
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Fax |
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Authorized Official
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Title or Position | OWNER 1
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Name | RITA JOHNSON MARTOR
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Credential |
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Telephone | 515-441-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | R 148120-4
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R 148120-4
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License Number State | MN
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