NPIMap

Organization Active NPI

Keokuk Area Group Home

  • Adult Care Home Facility
  • Keokuk, IA
National Provider Identifier
1790842615
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
560091 Issued in IA
Legal business name
KEOKUK AREA GROUP HOME
Practice address
317 High St
Keokuk, IA 52632-5939
Phone
(319) 524-1871
Fax
(319) 524-2612
NPI assigned
Jan 2, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Thomas J Jenkins
Title
QMRP Administrator
Phone
(319) 524-1871

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 560091 IA Primary

Addresses

Primary practice location

317 High St
Keokuk, IA 52632-5939

Mailing address

317 High St
Keokuk, IA 52632-5939
Phone (319) 524-1871

Other identifiers 1

IdentifierTypeStateIssuer
0893438MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Keokuk Area Group Home2 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.

Locations

317 High St
Keokuk, IA 52632
Phone (319) 524-1871

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": "1790842615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 HIGH ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526325939",
            "telephone_number": "319-524-1871",
            "fax_number": "319-524-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 HIGH ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526325939",
            "telephone_number": "319-524-1871",
            "fax_number": "319-524-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEOKUK AREA GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "QMRP ADMINISTRATOR",
        "authorized_official_telephone_number": "319-524-1871"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IA",
            "license": "560091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0893438",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keokuk, IA

Sources for this page

  • 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.