| Community Outreach Services, Llc | |
|
5870 Merle Hay Rd Suite D Johnston IA 50131-2816 | |
| (515) 309-1204 | |
| Not Available |
| Full Name | Community Outreach Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5870 Merle Hay Rd, Johnston, Iowa |
| Authorized Official Name and Position | James Edward Bustamante (CLINIC DIRECTOR) |
| Authorized Official Contact | 5153091204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Outreach Services, Llc Po Box 816 Johnston IA 50131-0816 Ph: (515) 309-1204 | Community Outreach Services, Llc 5870 Merle Hay Rd Suite D Johnston IA 50131-2816 Ph: (515) 309-1204 |
| NPI Number | 1740470343 |
|---|---|
| Provider Enumeration Date | 07/30/2007 |
| Last Update Date | 07/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740470343 | NPI | - | NPPES |
| 0011312 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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