Organization
ST. JUDE RETREAT HOUSE, LLC
Active
Other names
ALPP Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE VASQUEZ (CEO)
(800) 990-0340
Entity
Organization
Contact information
Practice address
5875 FLEUR DR, DES MOINES, IA 50321-2883
(800) 990-0340
(954) 208-5770
Mailing address
5875 FLEUR DR, DES MOINES, IA 50321-2883
(800) 990-0340
(954) 208-5770
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01930
IA
324500000X
Substance Abuse Rehabilitation Facility
Primary
1340
IA
363L00000X
Nurse Practitioner
A054289
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112726
—
IA
Enumeration date
05/21/2010
Last updated
12/16/2016
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