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General NPI Number Information
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NPI Number | 1871847202
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Entity Type | Organization
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Legal Business Name | ILLUMINATIONS, INC.
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 515 GRAND AVE STE 104
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City | AMES
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State | IA
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Zip | 50010-6061
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Country | US
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Telephone | 515-232-7157
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Fax | 515-232-7116
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Provider Business Mailing Address
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Address Line | 515 GRAND AVE STE 104
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City | AMES
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State | IA
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Zip | 50010-6061
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Country | US
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Telephone | 515-232-7157
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Fax | 515-232-7116
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH CARNINE
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Credential | L.I.S.W.
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Telephone | 515-232-7157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 01108
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License Number State | IA
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