Provider Demographics
NPI:1639471295
Name:UNITYPOINT AT HOME
Entity Type:Organization
Organization Name:UNITYPOINT AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-557-3191
Mailing Address - Street 1:PO BOX 35515
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-0305
Mailing Address - Country:US
Mailing Address - Phone:515-557-3100
Mailing Address - Fax:515-557-3186
Practice Address - Street 1:106 19TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3700
Practice Address - Country:US
Practice Address - Phone:309-779-7600
Practice Address - Fax:309-779-7252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITYPOINT AT HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-02
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA052551041C0700X
IL149.0048831041C0700X
IL209-005341363LF0000X
IL209003631363LF0000X
IA062587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216249Medicare PIN