Provider Demographics
NPI:1114256161
Name:CHILDREN'S CARE HOSPITAL AND SCHOOL DBA LIFESCAPE
Entity Type:Organization
Organization Name:CHILDREN'S CARE HOSPITAL AND SCHOOL DBA LIFESCAPE
Other - Org Name:LIFESCAPE ABLEKIDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-444-9711
Mailing Address - Street 1:2524 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106
Mailing Address - Country:US
Mailing Address - Phone:712-226-2253
Mailing Address - Fax:
Practice Address - Street 1:2524 GLENN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2768
Practice Address - Country:US
Practice Address - Phone:712-226-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S CARE HOSPITAL AND SCHOOL DBA LIFESCAPE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-21
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004071225100000X
IA001932225X00000X
IA01736235Z00000X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty