Organization
WESCO INDUSTRIES
Active
Other names
Camelot Square
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA BREWER (EXECUTIVE DIRECTOR)
(712) 263-6141
Entity
Organization
Contact information
Practice address
415 S 11TH ST, DENISON, IA 51442-2451
(712) 263-6141
(712) 263-4886
Mailing address
415 S 11TH ST, P.O. BOX 340, DENISON, IA 51442-2451
(712) 263-6141
(712) 263-4886
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120535
—
IA
05
—
0228346
—
IA
05
—
0893248
—
IA
Enumeration date
12/18/2006
Last updated
08/22/2020
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