Provider Demographics
NPI:1750104451
Name:URESCA LLC
Entity type:Organization
Organization Name:URESCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GORETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NABUKEERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-441-2619
Mailing Address - Street 1:1094 SE MAPLELEAF LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8227
Mailing Address - Country:US
Mailing Address - Phone:515-441-2619
Mailing Address - Fax:
Practice Address - Street 1:1094 SE MAPLELEAF LN
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8227
Practice Address - Country:US
Practice Address - Phone:515-441-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health