Provider Demographics
NPI:1154928497
Name:YESHUA REENTRY AND RECOVERY CENTER INC
Entity type:Organization
Organization Name:YESHUA REENTRY AND RECOVERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-339-9016
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50304-0836
Mailing Address - Country:US
Mailing Address - Phone:515-339-9016
Mailing Address - Fax:515-266-6029
Practice Address - Street 1:1235 SAMPSON ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316
Practice Address - Country:US
Practice Address - Phone:515-339-9016
Practice Address - Fax:515-266-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty