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611 5th Ave Ground Level Des Moines IA 50309-1603 | |
| (515) 274-9607 | |
| (515) 274-9614 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 611 5th Ave, Des Moines, Iowa |
| Authorized Official Name and Position | Shawn Hollenkamp (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5152374050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
611 5th Ave Ground Level Des Moines IA 50309-1603 Ph: (515) 274-9607 | 611 5th Ave Ground Level Des Moines IA 50309-1603 Ph: (515) 274-9607 |
| NPI Number | 1760855266 |
|---|---|
| Provider Enumeration Date | 11/05/2015 |
| Last Update Date | 11/05/2015 |
| Medicare PECOS PAC ID | 1456793900 |
|---|---|
| Medicare Enrollment ID | O20240529002403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760855266 | NPI | - | NPPES |
| 1140012 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 317887 (Iowa) | Primary |
| Provider Name | Anders Carl Dietz-swenson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063929784 PECOS PAC ID: 5496197949 Enrollment ID: I20240529002610 |
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