Basic Information
| Provider Information | |||||||||
| NPI: | 1487080297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AEGIS THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1433 SILVERWOOD LN | ||||||||
| Address2: | |||||||||
| City: | OTTUMWA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525013940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418142275 | ||||||||
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| Practice Location | |||||||||
| Address1: | 819 COUNTRY LANE RD | ||||||||
| Address2: | |||||||||
| City: | KEOSAUQUA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525651001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192933761 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2013 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | LARKIN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | KEVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | COTA | ||||||||
| AuthorizedOfficialTelephone: | 6418142275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | 000953 | IA | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.