MEDICARE: SUCCESSFUL LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		IA

General Provider Information

NPI Number	:	1275690224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESSFUL LIVING

Provider Business Mailing Address
First Line	:	409 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 HIGHWAY 1 W
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-4205
Country	:	US
Telephone Number	:	319-358-6800
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL R BOWERS
Credential	:
Telephone Number	:	319-358-6800

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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Directions to “SUCCESSFUL LIVING ” Practice Location

Language	Start Address	Practice Location

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