NPIMap

Organization Active NPI

Centers for Long Term Care of Iowa

Doing business as CLC Polk CIty

  • Skilled Nursing Facility
  • Polk City, IA
National Provider Identifier
1912967506
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CENTERS FOR LONG TERM CARE OF IOWA
Doing business as
CLC Polk CIty
Practice address
1002 W Washington Ave
Polk City, IA 50226-2132
Phone
(515) 984-6511
Fax
(515) 984-9294
NPI assigned
Mar 27, 2006
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
Gary R Trebert
Title
Ceo
Phone
(817) 359-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1002 W Washington Ave
Polk City, IA 50226-2132

Mailing address

PO Box 155635
Fort Worth, TX 76155-0635
Phone (817) 359-2000

Other identifiers 1

IdentifierTypeStateIssuer
0805192MedicaidIA

Other names 1

  • CLC Polk CIty Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Centers for Long Term Care of Iowa6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912967506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155635",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761550635",
            "telephone_number": "817-359-2000",
            "fax_number": "817-359-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 W WASHINGTON AVE",
            "city": "POLK CITY",
            "state": "IA",
            "postal_code": "502262132",
            "telephone_number": "515-984-6511",
            "fax_number": "515-984-9294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERS FOR LONG TERM CARE OF IOWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TREBERT",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-359-2000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805192",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLC Polk CIty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polk 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, 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.