| New Moon Wellness Qc Llc | |
|
2435 Kimberly Rd Ste 205n Bettendorf IA 52722-3521 | |
| (563) 484-0266 | |
| Not Available |
| Full Name | New Moon Wellness Qc Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2435 Kimberly Rd Ste 205n, Bettendorf, Iowa |
| Authorized Official Name and Position | Diane M Hudson (OWNER) |
| Authorized Official Contact | 5634840266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Moon Wellness Qc Llc Po Box 162 Mc Causland IA 52758-0162 Ph: (563) 484-0266 | New Moon Wellness Qc Llc 2435 Kimberly Rd Ste 205n Bettendorf IA 52722-3521 Ph: (563) 484-0266 |
| NPI Number | 1801663760 |
|---|---|
| Provider Enumeration Date | 12/11/2023 |
| Last Update Date | 06/03/2024 |
| Certification Date | 06/03/2024 |
| Medicare PECOS PAC ID | 1153774286 |
|---|---|
| Medicare Enrollment ID | O20240125001011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801663760 | NPI | - | NPPES |
| Provider Name | Diane Marie Hudson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306492285 PECOS PAC ID: 2062865199 Enrollment ID: I20240125001153 |
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