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General NPI Number Information
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NPI Number | 1629973607
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Entity Type | Organization
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Legal Business Name | DES MOINES OUTPATIENT LLC
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 1251 KEOSAUQUA WAY
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City | DES MOINES
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State | IA
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Zip | 50309-1013
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Country | US
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Telephone | 515-220-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 1251 KEOSAUQUA WAY
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City | DES MOINES
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State | IA
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Zip | 50309-1013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | DARCY BRAZZLE
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Credential |
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Telephone | 484-888-1200
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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 |
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License Number State | NULL
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