Organization
SELF-RELIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY JEAN MILLER (EXECUTIVE DIRECTOR)
(319) 752-4978
Entity
Organization
Contact information
Practice address
825 N 6TH ST STE 4, BURLINGTON, IA 52601-4920
(319) 752-4978
Mailing address
825 N 6TH ST STE 4, BURLINGTON, IA 52601-4920
(319) 752-4978
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
X000502991
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
X000502991
—
IA
Enumeration date
06/22/2015
Last updated
06/22/2015
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