Organization
COMMUNITY OUTREACH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES EDWARD BUSTAMANTE MA, LMHC, LPHA (CLINIC DIRECTOR)
(515) 309-1204
Entity
Organization
Contact information
Practice address
5870 MERLE HAY RD, SUITE D, JOHNSTON, IA 50131-2816
(515) 309-1204
Mailing address
PO BOX 816, JOHNSTON, IA 50131-0816
(515) 309-1204
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011312
—
IA
Enumeration date
07/30/2007
Last updated
07/30/2007
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