Basic Information
| Provider Information | |||||||||
| NPI: | 1366568065 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILDREN AND FAMILIES OF IOWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152881981 | ||||||||
| FaxNumber: | 5152889109 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503142329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152881981 | ||||||||
| FaxNumber: | 5152889109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5152881981 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | I | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | X | Agencies | Community/Behavioral Health | 323P00000X | 77PM29 | IA | X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | 1285 | IA | X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.