NPIMap

Organization Active NPI

St. Jude Retreat House, LLC

  • Substance Abuse Rehabilitation Facility
  • Des Moines, IA
National Provider Identifier
1184943797
Registry record updated Dec 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
1340 Issued in IA
Legal business name
ST. JUDE RETREAT HOUSE, LLC
Practice address
5875 Fleur Dr
Des Moines, IA 50321-2883
Phone
(800) 990-0340
Fax
(954) 208-5770
NPI assigned
May 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2016

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

Authorized official

Name
Mike Vasquez
Title
Ceo
Phone
(800) 990-0340

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 01930 IA
Substance Abuse Rehabilitation Facility 324500000X 1340 IA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X A054289 IA

Addresses

Primary practice location

5875 Fleur Dr
Des Moines, IA 50321-2883

Mailing address

5875 Fleur Dr
Des Moines, IA 50321-2883
Phone (800) 990-0340

Other identifiers 1

IdentifierTypeStateIssuer
0112726MedicaidIA

Other names 1

  • ALPP Institute Other name

National Provider Directory

National Provider Directory
Tax ID family
Alpp Institute6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1274400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1184943797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5875 FLEUR DR",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503212883",
            "telephone_number": "800-990-0340",
            "fax_number": "954-208-5770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5875 FLEUR DR",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503212883",
            "telephone_number": "800-990-0340",
            "fax_number": "954-208-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE RETREAT HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-21",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "VASQUEZ",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-990-0340"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IA",
            "license": "01930",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IA",
            "license": "1340",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A054289",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112726",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALPP Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; 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.