Childserve Habilitation Center Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

770916 Issued in IA

Legal business name

CHILDSERVE HABILITATION CENTER INC.

Doing business as

ChildServe Habilitation Center ICF/MR

Practice address

5900 Pioneer Pkwy
Johnston, IA 50131-1569

Phone

(515) 270-2205

Fax

(515) 276-0140

NPI assigned

Apr 23, 2007

Last updated

Jul 10, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

CHILDSERVE INC.As reported in NPPES

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

Addresses

Other identifiers 1

Other names 1

• ChildServe Habilitation Center ICF/MR Doing business as

Tax ID family

Childserve Habilitation Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Childserve Habilitation Center

  • Pediatric Skilled Nursing Facility
  • Johnston, IA
  • NPI 1962546374
  NPD tax ID

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1538387857",
    "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": "515-270-2205",
            "fax_number": "515-727-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 PIONEER PKWY",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311569",
            "telephone_number": "515-270-2205",
            "fax_number": "515-276-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDSERVE HABILITATION CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDSERVE INC.",
        "enumeration_date": "2007-04-23",
        "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": "770916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0880138",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ChildServe Habilitation Center ICF/MR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Central States Mobility Inc
• Daisy Alejandra Cerna Poster
• Lorraine Chidester, APRN, PMHNP
• Childserve Community Options, Inc.
• Childserve Habilitation Center
• Childserve Homecare Inc
• Childserve Homes Inc. (ChildServe Homes SCL Waiver)
• Childserve Homes Inc. (ChildServe Stonecrest Home)
• Childserve Homes Inc. (ChildServe Morningside Home)
• Childserve Homes Inc. (ChildServe Johnston Home)

• Intellectual Disabilities Intermediate Care Facility in Johnston, IA
• Providers in Johnston, IA by specialty
• Intellectual Disabilities Intermediate Care Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.