Organization Name: | INDIANOLA RESIDENTIAL, LLC |
NPI Number: | 1255412995 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUSSELL LEE HEMNESS (OWNER) |
Mailing Address: | 401 W Salem Ave Indianola |
State: | IA US |
Postal Code: | 501252439 |
Phone Number: | 5159612556 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 910290 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |