Provider Demographics
NPI:1689455289
Name:MIDWEST WELLNESS AND RECOVERY
Entity Type:Organization
Organization Name:MIDWEST WELLNESS AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CMA, CADC
Authorized Official - Phone:515-724-9896
Mailing Address - Street 1:100 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2116
Mailing Address - Country:US
Mailing Address - Phone:515-724-9896
Mailing Address - Fax:
Practice Address - Street 1:102 N WILSON AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-2116
Practice Address - Country:US
Practice Address - Phone:515-385-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility