Active NPI
Tanager Place
Doing business as Tanager Place PMIC
- Psychiatric Residential Treatment Facility
- Cedar Rapids, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Residential Treatment Facility
- License
- 57PM-0005
- Legal business name
- TANAGER PLACE
- Doing business as
- Tanager Place PMIC
- Practice address
- 2309 C St SW
Cedar Rapids, IA 52404-3707 - Phone
- (319) 365-9164
- Fax
- (319) 365-6411
- NPI assigned
- Dec 29, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeff Humiston
- Title
- C.F.O.
- Phone
- (319) 365-9164
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Residential Treatment Facility | 323P00000X | 57PM-0005 | IA | Primary |
Addresses
Primary practice location
2309 C St SW
Cedar Rapids, IA 52404-3707
Mailing address
2309 C St SW
Cedar Rapids, IA 52404-3707
Phone (319) 365-9164
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0047639 | Medicaid | IA |
Other names 1
- Tanager Place PMIC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 4
The Medicare certification numbers (CCNs) connected to NPI 1114083474. Details of each certification follow.
Psychiatric residential treatment facility certification: CCN 16L010
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- TANAGER PLACE-COOK COTTAGE
- Certification status
- Active
- Provider type (POS)
- Psychiatric residential treatment facility
- Participating since
- Sep 26, 2018
- Last certification
- Sep 26, 2018
- Beds
- 12
- Ownership / control type
- For profit – individual
- Facility address
- 2309 C Street SW
Cedar Rapids, IA 52404
Psychiatric residential treatment facility certification: CCN 16L011
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- TANAGER PLACE-DUTTON COTTAGE
- Certification status
- Active
- Provider type (POS)
- Psychiatric residential treatment facility
- Participating since
- Aug 9, 2019
- Last certification
- Jan 9, 2025
- Beds
- 12
- Ownership / control type
- For profit – individual
- Facility address
- 2309 C Street SW
Cedar Rapids, IA 52404
Psychiatric residential treatment facility certification: CCN 16L012
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- TANAGER PLACE-TOMLINSON COTTAGE
- Certification status
- Active
- Provider type (POS)
- Psychiatric residential treatment facility
- Participating since
- Mar 1, 2005
- Last certification
- Jan 8, 2025
- Beds
- 12
- Ownership / control type
- For profit – individual
- Facility address
- 2309 C Street SW
Cedar Rapids, IA 52404
Psychiatric residential treatment facility certification: CCN 16L013
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- TANAGER PLACE-VAN VECHTEN COTTAGE
- Certification status
- Active
- Provider type (POS)
- Psychiatric residential treatment facility
- Participating since
- Jul 22, 2001
- Last certification
- Sep 23, 2022
- Beds
- 12
- Ownership / control type
- For profit – individual
- Facility address
- 2309 C Street SW
Cedar Rapids, IA 52404
National Provider Directory
National Provider Directory- Tax ID family
- Tanager Place
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Cedar Rapids, IA
- NPI 1023147089
-
- Voluntary or Charitable Agency
- Cedar Rapids, IA
- NPI 1508992504
-
dba Tanager Place ICFMR
- Intellectual Disabilities Intermediate Care Facility
- Cedar Rapids, IA
- NPI 1699832477
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1114083474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2309 C ST SW",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524043707",
"telephone_number": "319-365-9164",
"fax_number": "319-365-6411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2309 C ST SW",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524043707",
"telephone_number": "319-365-9164",
"fax_number": "319-365-6411"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TANAGER PLACE",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-29",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "HUMISTON",
"authorized_official_first_name": "JEFF",
"authorized_official_title_or_position": "C.F.O.",
"authorized_official_telephone_number": "319-365-9164",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "323P00000X",
"taxonomy_group": "",
"desc": "Psychiatric Residential Treatment Facility",
"state": "IA",
"license": "57PM-0005",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0047639",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Tanager Place PMIC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.