NPIMap

Organization Active NPI

Childserve Homes Inc.

Doing business as ChildServe Homes SCL Waiver

  • Mental Illness Intermediate Care Facility
  • Johnston, IA
National Provider Identifier
1124162532
Registry record updated Jun 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
Legal business name
CHILDSERVE HOMES INC.
Doing business as
ChildServe Homes SCL Waiver
Practice address
5406 Merle Hay Rd
Johnston, IA 50131-1209
Phone
(515) 727-8750
Fax
(515) 727-8757
NPI assigned
Feb 18, 2007
Last updated
Jun 2, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDSERVE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rodney Wildrick
Title
Director of Accounting
Phone
(515) 727-1468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X NU Primary

Addresses

Primary practice location

5406 Merle Hay Rd
Johnston, IA 50131-1209

Mailing address

PO Box 707
Johnston, IA 50131-0707
Phone (515) 727-8750

Other identifiers 1

IdentifierTypeStateIssuer
0122119MedicaidIA

Other names 1

  • ChildServe Homes SCL Waiver Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Childserve Homes Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275436800000",
    "number": "1124162532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501310707",
            "telephone_number": "515-727-8750",
            "fax_number": "515-727-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5406 MERLE HAY RD",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311209",
            "telephone_number": "515-727-8750",
            "fax_number": "515-727-8757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDSERVE HOMES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDSERVE INC.",
        "enumeration_date": "2007-02-18",
        "last_updated": "2010-06-02",
        "status": "A",
        "authorized_official_last_name": "WILDRICK",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "515-727-1468"
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0122119",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ChildServe Homes SCL Waiver",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnston, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.