Her Support Llc | |
5550 Wild Rose Ln Ste 400 West Des Moines IA 50266-5351 | |
(515) 322-7986 | |
Not Available |
Full Name | Her Support Llc |
---|---|
Speciality | Social Worker |
Location | 5550 Wild Rose Ln Ste 400, West Des Moines, Iowa |
Authorized Official Name and Position | Denise Edwards (OWNER) |
Authorized Official Contact | 6304059336 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Her Support Llc 5465 Mills Civic Pkwy Ste 3319 West Des Moines IA 50266-5318 Ph: (515) 322-7986 | Her Support Llc 5550 Wild Rose Ln Ste 400 West Des Moines IA 50266-5351 Ph: (515) 322-7986 |
NPI Number | 1245795863 |
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Provider Enumeration Date | 02/07/2019 |
Last Update Date | 10/28/2020 |
Certification Date | 10/28/2020 |
Medicare PECOS PAC ID | 7214357946 |
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Medicare Enrollment ID | O20201020000515 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245795863 | NPI | - | NPPES |
104100000X | Other | IA | TAXONOMY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
104100000X | Social Worker | (* (Not Available)) | Primary |
Provider Name | Denise L Kelley Edwards |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1730615881 PECOS PAC ID: 7315214426 Enrollment ID: I20170522000164 |
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