Indianola Residential, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

910290 Issued in IA

Legal business name

INDIANOLA RESIDENTIAL, LLC

Practice address

401 W Salem Ave
Indianola, IA 50125-2439

Phone

(515) 961-2556

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Russell Lee Hemness

Title

Owner

Phone

(515) 250-0670

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Indianola Residential Doing business as

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255412995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5095 WINDSOR CIR",
            "city": "PLEASANT HILL",
            "state": "IA",
            "postal_code": "503270908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W SALEM AVE",
            "city": "INDIANOLA",
            "state": "IA",
            "postal_code": "501252439",
            "telephone_number": "515-961-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANOLA RESIDENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEMNESS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-250-0670"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "IA",
            "license": "910290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0896910",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indianola Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Indianola, IA
• Providers in Indianola, IA by specialty
• Mental Illness Community Based Residential Treatment Facility in Iowa

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.