# ACTIVELY SUPPORTING INDIVIDUALS WITH CHALLENGES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790073625
- **Authorized official:** DERIK L SHIELDS (OWNER)
- **Authorized official phone:** (402) 917-5163

## Contact information

- **Practice address:** 301 SCOTT ST, GRISWOLD, IA 51535-2044
- **Practice address phone:** (402) 917-5163
- **Mailing address:** 301 SCOTT ST, GRISWOLD, IA 51535-2044
- **Mailing address phone:** (402) 917-5163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | IA | Yes |

## Other

- **Enumeration date:** 07/12/2011
- **Last updated:** 07/12/2011