Organization
NEW VENTURE GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MENDY MIDDLEBROOK BA (TEMPORARY ADMINISTRATOR)
(641) 872-1524
Entity
Organization
Contact information
Practice address
401 S WASHINGTON ST, CORYDON, IA 50060-1745
(641) 872-1524
(641) 872-2843
Mailing address
401 S WASHINGTON ST, CORYDON, IA 50060-1745
(641) 872-1524
(641) 872-2843
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
RMR-413
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0375474D
—
IA
05
—
0779733E
—
IA
05
—
0903780C
—
IA
05
—
1484676D
—
IA
05
—
2144725H
—
IA
Enumeration date
05/22/2007
Last updated
08/01/2008
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