NPIMap

Organization Active NPI

Crittenton Center

  • Community/Behavioral Health Agency
  • Sioux City, IA
National Provider Identifier
1861276123
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CRITTENTON CENTER
Practice address
3901 Green Ave
Sioux City, IA 51106-5346
Phone
(712) 255-4321
Fax
(712) 252-4743
NPI assigned
Aug 18, 2023
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Dr. Beau Sudtelgte, ED.D.
Title
Chief Financial Officer
Phone
(712) 255-4321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3901 Green Ave
Sioux City, IA 51106-5346

Mailing address

600 4TH St Ste 100
Sioux City, IA 51101-1745
Phone (712) 255-4321

Other identifiers 3

IdentifierTypeStateIssuer
1205915261MedicaidIA
1215070438MedicaidIA
1295818334MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Crittenton Center4 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1861276123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 4TH ST STE 100",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011745",
            "telephone_number": "712-255-4321",
            "fax_number": "712-252-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 GREEN AVE",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511065346",
            "telephone_number": "712-255-4321",
            "fax_number": "712-252-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRITTENTON CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "SUDTELGTE",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "712-255-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205915261",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215070438",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295818334",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.