Organization
CEDAR VALLEY COMMUNITY SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANIZE MAMODALY (CO-OWNER)
(319) 233-1288
Entity
Organization
Contact information
Practice address
3121 BROCKWAY RD, WATERLOO, IA 50701-5103
(319) 233-1288
(319) 233-1461
Mailing address
3121 BROCKWAY RD, WATERLOO, IA 50701-5103
(319) 233-1288
(319) 233-1461
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0249854
—
IA
05
—
0250043
—
IA
05
—
0741280
—
IA
Enumeration date
10/24/2006
Last updated
08/22/2020
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