MEDICARE: CDAC SERVICES OF IOWA, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1750661179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDAC SERVICES OF IOWA, LLC

Provider Business Mailing Address
First Line	:	14586 SCOTCH RIDGE RD
Second Line	:	P.O. BOX 426
City	:	CARLISLE
State	:	IA
Zip	:	50047-3131
Country	:	US
Telephone Number	:	515-953-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	14586 SCOTCH RIDGE RD
Second Line	:
City	:	CARLISLE
State	:	IA
Zip	:	50047-3131
Country	:	US
Telephone Number	:	515-953-2755
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	MR. JOHN H JUDISCH
Credential	:	J.D.
Telephone Number	:	515-953-2755

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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