NPIMap

Organization Active NPI

Community Outreach Services, LLC

  • Community/Behavioral Health Agency
  • Johnston, IA
National Provider Identifier
1740470343
Registry record updated Jul 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COMMUNITY OUTREACH SERVICES, LLC
Practice address
5870 Merle Hay Rd
Suite D
Johnston, IA 50131-2816
Phone
(515) 309-1204
NPI assigned
Jul 30, 2007
Last updated
Jul 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2007

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

Authorized official

Name
James Edward Bustamante, MA, LMHC, LPHA
Title
Clinic Director
Phone
(515) 309-1204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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 1

IdentifierTypeStateIssuer
0011312MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Community Outreach Services LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1740470343",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OUTREACH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "BUSTAMANTE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "515-309-1204",
        "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": "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 Jul 30, 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.