Provider Demographics
NPI:1558536524
Name:HEALING PLACE, L.L.C.
Entity Type:Organization
Organization Name:HEALING PLACE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:563-242-9210
Mailing Address - Street 1:215 6TH AVE S
Mailing Address - Street 2:STE 25
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4338
Mailing Address - Country:US
Mailing Address - Phone:563-242-9210
Mailing Address - Fax:563-243-0730
Practice Address - Street 1:215 6TH AVE S
Practice Address - Street 2:STE 25
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4338
Practice Address - Country:US
Practice Address - Phone:563-242-9210
Practice Address - Fax:563-243-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility