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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CARLA BILLUPS CALDWELL (MANAGING PARTNER)
(708) 310-0600
Entity
Organization

Contact information

Practice address
209 CANDLEWICK RD, WATERLOO, IA 50703-1303
(319) 240-2119
Mailing address
909 WILLOW RD, MATTESON, IL 60443-1981
(708) 310-0600
(708) 620-5317

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
00725
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
X000402816
IA
Enumeration date
09/16/2010
Last updated
09/16/2010
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