Indianola Residential, Llc

NPI 1255412995 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1255412995
Enumeration Date 10/18/2006
Last Updated 07/09/2007
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name RUSSELL LEE RUSSELL
Position OWNER
Phone (515) 961-2556
Fax
Practice Location
401 W SALEM AVE
INDIANOLA IA, 50125-2439, US
Phone (515) 961-2556
Fax
Business Location
5095 WINDSOR CIR
PLEASANT HILL IA, 50327-0908, US
Phone
Fax
Toxanomy
Taxonomy Code 320800000X
License State Iowa
License Number 910290
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According to our database, Indianola Residential, Llc NPI is 1255412995, taxonomy code is 320800000X and license number is 910290, license state is located at Iowa. Indianola Residential, Llc physically located at 401 W Salem Ave, Indianola IA, 50125-2439. NPI Number 1033115704 has the healthcare provider type.

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1255412995 NPI number is provided on an as is basis without warranty of any kind. 1255412995 is maintained by the National Plan & Provider Enumeration System. The contents of Indianola Residential, Llc are for informational purposes only.