Provider Demographics
NPI:1568290831
Name:HEALTHPRO DISABILITY CARE LLC
Entity type:Organization
Organization Name:HEALTHPRO DISABILITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:KEDJU
Authorized Official - Last Name:FOASUNG-ZAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-918-4012
Mailing Address - Street 1:315 E 5TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4757
Mailing Address - Country:US
Mailing Address - Phone:602-918-4012
Mailing Address - Fax:
Practice Address - Street 1:315 E 5TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4757
Practice Address - Country:US
Practice Address - Phone:602-918-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child