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General NPI Number Information
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NPI Number | 1962864926
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Entity Type | Organization
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Legal Business Name | DIERCKS SENIOR CARE LLC
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 1844 W RIDGEWAY AVE
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City | WATERLOO
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State | IA
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Zip | 50701-4546
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Country | US
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Telephone | 319-235-5999
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Fax | 319-234-1794
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Provider Business Mailing Address
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Address Line | 1844 W RIDGEWAY AVE
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City | WATERLOO
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State | IA
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Zip | 50701-4546
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Country | US
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Telephone | 319-235-5999
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Fax | 319-234-1794
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Authorized Official
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Title or Position | CO-OWNER
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Name | KEVIN L DIERCKS
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Credential |
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Telephone | 319-235-5999
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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 | IA
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