NPIMap

Organization Active NPI

Childserve Homes Inc.

Doing business as ChildServe Keystone Home

  • Intellectual Disabilities Intermediate Care Facility
  • Grimes, IA
National Provider Identifier
1952443780
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
771149 Issued in IA
Legal business name
CHILDSERVE HOMES INC.
Doing business as
ChildServe Keystone Home
Practice address
10350 Stone Ridge St
Grimes, IA 50111-2303
Phone
(515) 986-0554
Fax
(515) 986-0578
NPI assigned
Feb 12, 2007
Last updated
Jul 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Authorized official

Name
Rodney Wildrick
Title
Director of Accounting
Phone
(515) 727-1468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 771149 IA Primary

Addresses

Primary practice location

10350 Stone Ridge St
Grimes, IA 50111-2303

Mailing address

PO Box 707
Johnston, IA 50131-0707
Phone (515) 727-8750

Other identifiers 1

IdentifierTypeStateIssuer
0882118MedicaidIA

Other names 1

  • ChildServe Keystone Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Childserve Homes Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1952443780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501310707",
            "telephone_number": "515-727-8750",
            "fax_number": "515-727-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10350 STONE RIDGE ST",
            "city": "GRIMES",
            "state": "IA",
            "postal_code": "501112303",
            "telephone_number": "515-986-0554",
            "fax_number": "515-986-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDSERVE HOMES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "WILDRICK",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNTING",
        "authorized_official_telephone_number": "515-727-1468"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IA",
            "license": "771149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0882118",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ChildServe Keystone Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grimes, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.