Organization
LIFE EXTENDED HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NTWARI N GAKUNZI (CEO)
(515) 943-6732
Entity
Organization
Contact information
Practice address
5505 145TH STREET, N/A, URBANDALE, IA 50323
(515) 943-6732
Mailing address
5505 145TH STREET, N/A, URBANDALE, IA 50323
(515) 943-6732
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253J00000X
Foster Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
10/30/2024
Last updated
10/30/2024
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