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General NPI Number Information
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NPI Number | 1609436492
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Entity Type | Organization
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Legal Business Name | TYNIQUES ROSE GARDEN
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 14406 HOLCOMB AVE
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City | URBANDALE
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State | IA
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Zip | 50323-2771
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Country | US
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Telephone | 402-707-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 14406 HOLCOMB AVE
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City | URBANDALE
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State | IA
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Zip | 50323-2771
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Country | US
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Telephone | 402-707-0615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIQUE DEVERS
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Credential |
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Telephone | 402-707-0615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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