Provider Demographics
NPI: | 1033449145 |
---|---|
Name: | THE CHILDSERVE CLINIC INC |
Entity Type: | Organization |
Organization Name: | THE CHILDSERVE CLINIC INC |
Other - Org Name: | CHILDSERVE CLINICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR OF FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PAVLOVEC |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 515-727-1463 |
Mailing Address - Street 1: | PO BOX 707 |
Mailing Address - Street 2: | |
Mailing Address - City: | JOHNSTON |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50131-0707 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 515-727-8750 |
Mailing Address - Fax: | 515-727-8757 |
Practice Address - Street 1: | 5406 MERLE HAY RD |
Practice Address - Street 2: | |
Practice Address - City: | JOHNSTON |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50131-1209 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-727-8750 |
Practice Address - Fax: | 515-727-8757 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-01-12 |
Last Update Date: | 2020-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty |