Active NPI
Community Outreach Services, LLC
- Community/Behavioral Health Agency
- Johnston, IA
National Provider Identifier
1386861045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- COMMUNITY OUTREACH SERVICES, LLC
- Practice address
- 5870 Merle Hay Rd
Suite D
Johnston, IA 50131-2816 - Phone
- (515) 309-1204
- Fax
- (515) 309-2525
- NPI assigned
- Apr 20, 2007
- 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
- James E Bustamante, MA, LMHC, LPHA
- Title
- Clinic Director
- Phone
- (515) 727-0702
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | NU | Primary |
Addresses
Primary practice location
5870 Merle Hay Rd
Suite D
Johnston, IA 50131-2816
Mailing address
PO Box 816
Johnston, IA 50131-0816
Phone (515) 309-1204
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1011312 | Medicaid | IA | |
| 0469106 | Medicaid | IA | |
| 0011312 | Medicaid | IA |
National Provider Directory
National Provider Directory- Tax ID family
- Community Outreach Services LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Johnston, IA
- NPI 1568652162
-
- Community/Behavioral Health Agency
- Johnston, IA
- NPI 1740470343
Locations
5870 Merle Hay Rd
Ste D
Johnston, IA 50131
Phone (515) 309-1204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1386861045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 816",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501310816",
"telephone_number": "515-309-1204",
"fax_number": "515-309-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5870 MERLE HAY RD",
"address_2": "SUITE D",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501312816",
"telephone_number": "515-309-1204",
"fax_number": "515-309-2525"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY OUTREACH SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BUSTAMANTE",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "CLINIC DIRECTOR",
"authorized_official_telephone_number": "515-727-0702",
"authorized_official_credential": "MA, LMHC, LPHA"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1011312",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0469106",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0011312",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}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 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.