Proffitt's Residential

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

R542 Issued in IA

Legal business name

PROFFITT'S RESIDENTIAL

Practice address

615 West Washington St
Centerville, IA 52544-1623

Phone

(641) 856-8344

Fax

(641) 437-4161

NPI assigned

Mar 9, 2007

Organization subpart

No

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

Authorized official

Name

Mary Catherine Proffitt

Title

Owner

Phone

(641) 856-8344

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750412672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W WASHINGTON ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525441623",
            "telephone_number": "641-856-8344",
            "fax_number": "641-437-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 WEST WASHINGTON ST",
            "city": "CENTERVILLE",
            "state": "IA",
            "postal_code": "525441623",
            "telephone_number": "641-856-8344",
            "fax_number": "641-437-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFFITT'S RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "CATHERINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "641-856-8344"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IA",
            "license": "R542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Centerville, IA
• Providers in Centerville, IA by specialty
• Adult Care Home Facility in Iowa

• 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.

Verify at the official NPI Registry.