Organization
HEALTHPRO DISABILITY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATHIAS KEDJU FOASUNG-ZAH (SOLE MEMBER)
(602) 918-4012
Entity
Organization
Contact information
Practice address
315 E 5TH ST STE 202, WATERLOO, IA 50703-4757
(602) 918-4012
Mailing address
315 E 5TH ST STE 202, WATERLOO, IA 50703-4757
(602) 918-4012
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
07/26/2024
Last updated
08/27/2024
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