1952434680 NPI number — A1 ADDICTIONS RECOVERY CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952434680 NPI number — A1 ADDICTIONS RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A1 ADDICTIONS RECOVERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952434680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 AND ONE HALF NILE KINNICK DRIVE SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADEL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-993-4246
Provider Business Mailing Address Fax Number:
515-993-4256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50265-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-993-4246
Provider Business Practice Location Address Fax Number:
515-993-4245
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DICKERSON
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
515-993-4246

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com