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Organization
MIDWEST COMFORTABLE LIVING LLC
Active
Organization
MIDWEST COMFORTABLE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOQUANA GOYNES (EXECUTIVE DIRECTOR)
(515) 824-2988
Entity
Organization
Contact information
Practice address
319 S 17TH ST STE 722, OMAHA, NE 68102-1911
(402) 378-5755
Mailing address
811 SE 10TH LN, GRIMES, IA 50111-3006
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
98864151
—
NE
Enumeration date
12/28/2020
Last updated
12/28/2020
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