Provider Demographics
NPI:1255477329
Name:WILLIAM EADIE RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:WILLIAM EADIE RESIDENTIAL SERVICES, INC.
Other - Org Name:CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:6417-828-8495
Mailing Address - Street 1:500 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:IA
Mailing Address - Zip Code:50830-1078
Mailing Address - Country:US
Mailing Address - Phone:641-347-5611
Mailing Address - Fax:641-347-5038
Practice Address - Street 1:500 OPAL ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:IA
Practice Address - Zip Code:50830-1078
Practice Address - Country:US
Practice Address - Phone:641-347-5611
Practice Address - Fax:641-347-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-880682 & R-880683251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0895482Medicaid
IA0233528Medicaid
IA0463406Medicaid