Provider Demographics
NPI:1588295695
Name:CENTER FOR FOUNDATIONAL & RELATIONAL WELLNESS LLC
Entity type:Organization
Organization Name:CENTER FOR FOUNDATIONAL & RELATIONAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-231-9399
Mailing Address - Street 1:2022 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2010
Mailing Address - Country:US
Mailing Address - Phone:319-596-5910
Mailing Address - Fax:
Practice Address - Street 1:2022 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2010
Practice Address - Country:US
Practice Address - Phone:319-596-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health