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General NPI Number Information
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NPI Number | 1043352875
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Entity Type | Organization
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Legal Business Name | CHILDSERVE HOMES INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 7161 WILSHIRE BLVD
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50322-4823
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Country | US
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Telephone | 515-276-3612
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Fax | 515-331-7706
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Provider Business Mailing Address
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Address Line | PO BOX 707
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City | JOHNSTON
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State | IA
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Zip | 50131-0707
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Country | US
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Telephone | 515-727-8750
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Fax | 515-727-8757
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNTING
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Name | RODNEY WILDRICK
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Credential |
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Telephone | 515-727-1468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 771147
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License Number State | IA
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