Chelsae Wagner
Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Wyoming, IA
NPI 1003566985 · NPPES record last updated Mar 24, 2022
Key facts
- NPI
- 1003566985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Practice address
- 8005 County Road E45
Wyoming, IA 52362-7514 - Phone
- (319) 929-8702
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Unique Affinity Dynamics, LLC | Assisted Living, Mental Illness | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | |||
| Assisted Living Facility (Behavioral Disturbances) | 3104A0630X | |||
| Mental Illness Community Based Residential Treatment Facility | 320800000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
8005 County Road E45
Wyoming, IA 52362-7514
Mailing address
8005 County Road E45
Wyoming, IA 52362-7514
Phone (319) 929-8702
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480CC0877 | Other | IA | DRIVERS LICENSE |
Other providers in Wyoming, IA
- Medical Associates of Maquoketa PC
- Midland Ambulance Service
- Midland Community Schools
- Prescription Shoppe Telepharmacy, LLC
- Monica Rodriguez
- Wyoming Chiropractic Clinic LLC
All providers in Wyoming, IA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.