NPIMap

Organization Active NPI

Tanager Place

Doing business as Tanager Place ICFMR

  • Intellectual Disabilities Intermediate Care Facility
  • Cedar Rapids, IA
National Provider Identifier
1699832477
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
570936 Issued in IA
Legal business name
TANAGER PLACE
Doing business as
Tanager Place ICFMR
Practice address
2309 C St SW
Cedar Rapids, IA 52404-3707
Phone
(319) 365-9164
Fax
(319) 365-6411
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jeff Humiston
Title
C.F.O.
Phone
(319) 365-9164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 570936 IA Primary

Addresses

Primary practice location

2309 C St SW
Cedar Rapids, IA 52404-3707

Mailing address

2309 C St SW
Cedar Rapids, IA 52404-3707
Phone (319) 365-9164

Other identifiers 1

IdentifierTypeStateIssuer
0881755MedicaidIA

Other names 1

  • Tanager Place ICFMR Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699832477. Details of each certification follow.

  • CCN 16G139 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 16G139

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
TANAGER PLACE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 15, 2003
Last certification
Jun 5, 2025
Beds
21
Ownership / control type
Private (non-profit)
Most recent change of ownership
Jun 14, 2022
Facility address
2309 C Street SW
Cedar Rapids, IA 52404

National Provider Directory

National Provider Directory
Tax ID family
Tanager Place4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699832477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 C ST SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524043707",
            "telephone_number": "319-365-9164",
            "fax_number": "319-365-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 C ST SW",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524043707",
            "telephone_number": "319-365-9164",
            "fax_number": "319-365-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANAGER PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUMISTON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "319-365-9164",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IA",
            "license": "570936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881755",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tanager Place ICFMR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cedar Rapids, IA

Sources for this page

Verify at the official NPI Registry.