Provider Demographics
NPI:1053400960
Name:UNITYPOINT AT HOME
Entity type:Organization
Organization Name:UNITYPOINT AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP ACCREDITATION AND REG AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-557-3100
Mailing Address - Street 1:1776 W LAKES PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8378
Mailing Address - Country:US
Mailing Address - Phone:515-557-3100
Mailing Address - Fax:
Practice Address - Street 1:11333 AURORA AVE.
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-557-3100
Practice Address - Fax:515-557-3186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITYPOINT AT HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5055332B00000X
SD400-02983336H0001X
NE1573336H0001X
IA113336H0001X
MN2651723336H0001X
MO20150281283336H0001X
AZY0070853336H0001X
WI258-433336H0001X
IL54.0154783336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0193888Medicaid
IL=========-001Medicaid
IL=========-001Medicaid
IL=========-001Medicaid