Provider Demographics
NPI:1235643941
Name:CEDAR RAPIDS IA HOME CARE LLC
Entity Type:Organization
Organization Name:CEDAR RAPIDS IA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BETTERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:319-320-2069
Mailing Address - Street 1:1221 PARK PL NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2001
Mailing Address - Country:US
Mailing Address - Phone:319-320-2069
Mailing Address - Fax:
Practice Address - Street 1:1221 PARK PL NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2001
Practice Address - Country:US
Practice Address - Phone:319-320-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA253Z00000X, 311500000X, 385H00000X
385HR2055X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child