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Organization
LEE WOLF
Active
Organization
LEE WOLF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE WOLF (OWNER)
(712) 883-2893
Entity
Organization
Contact information
Practice address
4066 320TH ST, MAPLETON, IA 51034-8005
(712) 883-2893
(712) 883-2894
Mailing address
4066 320TH ST, MAPLETON, IA 51034-8005
(712) 883-2893
(712) 883-2894
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0479691
—
IA
Enumeration date
04/10/2007
Last updated
06/23/2008
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