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General NPI Number Information
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NPI Number | 1750696852
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Entity Type | Organization
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Legal Business Name | COMMUNITY NEUROREHAB OF IOWA
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 3000 SW 37TH ST
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City | DES MOINES
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State | IA
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Zip | 50321-1330
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Country | US
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Telephone | 515-288-8222
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 SW 37TH ST
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City | DES MOINES
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State | IA
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Zip | 50321-1330
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Country | US
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Telephone | 515-288-8222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN L POLKOW
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Credential |
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Telephone | 415-209-9802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 771045
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 771045
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License Number State | IA
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