NPIMap

Organization Active NPI

Childserve Homes Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Des Moines, IA
National Provider Identifier
1487795449
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
770677 Issued in IA
Legal business name
CHILDSERVE HOMES INC.
Practice address
3610 42ND St
Des Moines, IA 50310-4158
Phone
(515) 274-9448
Fax
(515) 274-8326
NPI assigned
Feb 10, 2007
Organization subpart
Yes
Parent organization
CHILDSERVE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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
Intellectual Disabilities Intermediate Care Facility 315P00000X 770677 IA Primary

Addresses

Primary practice location

3610 42ND St
Des Moines, IA 50310-4158

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0881425MedicaidIA

Other names 1

  • ChildServe Beaverdale Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 16G127

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
CHILDSERVE HOMES - BEAVERDALE HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 27, 1996
Last certification
May 22, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
3610 42ND Street
Des Moines, IA 50310

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.

Locations

3610 42nd St
Des Moines, IA 50310
Phone (515) 274-9448

NPI Registry JSON

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1487795449",
    "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": "3610 42ND ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503104158",
            "telephone_number": "515-274-9448",
            "fax_number": "515-274-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDSERVE HOMES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDSERVE INC.",
        "enumeration_date": "2007-02-10",
        "last_updated": "2007-07-10",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IA",
            "license": "770677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881425",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ChildServe Beaverdale Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.