Organization
BLACK HAWK CENTER FOR INDEPENDENT LIVING
Active
Other names
Prime Time Pass
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SCHUMAKER (EXECUTIVE DIRECTOR)
(319) 291-7755
Entity
Organization
Contact information
Practice address
312 JEFFERSON ST, WATERLOO, IA 50701-1322
(319) 291-7755
(319) 291-7781
Mailing address
312 JEFFERSON ST, WATERLOO, IA 50701-1322
(319) 291-7755
(319) 291-7781
Taxonomy
Speciality
Code
Description
License number
State
347B00000X
Bus
Primary
0454736
IA
Other
Enumeration date
04/22/2007
Last updated
08/22/2020
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