MEDICARE: DES MOINES WELLNESS CENTER

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	323P00000X	Psychiatric Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1841153608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DES MOINES WELLNESS CENTER

Provider Business Mailing Address
First Line	:	621 NW 53RD ST STE 370
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-8241
Country	:	US
Telephone Number	:	978-440-3200
Fax Number	:	323-529-8134

Provider Business Practice Location Address
First Line	:	5820 WINWOOD DR
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-1821
Country	:	US
Telephone Number	:	978-440-3200
Fax Number	:	323-529-8134

Authorized Official
Title or Position	:	CEO
Name	:	NICHOLAS ADAM PETRILLO
Credential	:
Telephone Number	:	978-440-3200

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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