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General NPI Number Information
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NPI Number | 1548805021
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Entity Type | Organization
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Legal Business Name | CENTRAL IOWA TRAUMA AND RECOVERY CENTER
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 301 E COURT AVE STE 105
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City | DES MOINES
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State | IA
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Zip | 50309-2004
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Country | US
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Telephone | 515-770-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E COURT AVE STE 105
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City | DES MOINES
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State | IA
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Zip | 50309-2004
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Country | US
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Telephone | 515-244-5372
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ALYSON SIMMONS
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Credential |
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Telephone | 515-244-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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