Provider Demographics
NPI:1932266996
Name:ANGELHEART FAMILY & COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:ANGELHEART FAMILY & COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KLEIST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:319-377-0770
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-0525
Mailing Address - Country:US
Mailing Address - Phone:319-377-0770
Mailing Address - Fax:319-377-5120
Practice Address - Street 1:222 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1509
Practice Address - Country:US
Practice Address - Phone:319-377-0770
Practice Address - Fax:319-377-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00105251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare