Provider Demographics
NPI:1114075561
Name:YOUTH EMERGENCY SERVICES & SHELTER OF IOWA
Entity Type:Organization
Organization Name:YOUTH EMERGENCY SERVICES & SHELTER OF IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:QUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-243-7825
Mailing Address - Street 1:918 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5324
Mailing Address - Country:US
Mailing Address - Phone:515-243-7825
Mailing Address - Fax:515-282-6162
Practice Address - Street 1:918 SE 11TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5324
Practice Address - Country:US
Practice Address - Phone:515-243-7825
Practice Address - Fax:515-282-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0488007Medicaid
IA1104471Medicaid