Provider Demographics
NPI:1912454695
Name:ST. GREGORY RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:ST. GREGORY RECOVERY CENTER, LLC
Other - Org Name:ALPP INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARMODY
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-974-7487
Mailing Address - Street 1:1211 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4472
Mailing Address - Country:US
Mailing Address - Phone:888-778-5833
Mailing Address - Fax:
Practice Address - Street 1:608 NORTH ST
Practice Address - Street 2:
Practice Address - City:ADAIR
Practice Address - State:IA
Practice Address - Zip Code:50002-1126
Practice Address - Country:US
Practice Address - Phone:712-662-4701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. GREGORY CENTERS HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1332324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112726Medicaid