Provider Demographics
NPI:1437147907
Name:CREST SERVICES
Entity Type:Organization
Organization Name:CREST SERVICES
Other - Org Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SONSTEBY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-941-3175
Mailing Address - Street 1:3015 MERLE HAY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1270
Mailing Address - Country:US
Mailing Address - Phone:515-331-1200
Mailing Address - Fax:515-331-1220
Practice Address - Street 1:3015 MERLE HAY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1270
Practice Address - Country:US
Practice Address - Phone:515-331-1200
Practice Address - Fax:515-331-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0121798Medicaid
IA0892455OtherSTATE SUPPLEMENTAL ASSIST
IA0894915OtherSTATE SUPPLEMENTAL ASSIST
IA0172577Medicaid
IA0892240OtherSTATE SUPPLEMENTAL ASSIST
IA0895946OtherSTATE SUPPLEMENTAL ASSIST
IA0096032Medicaid
IA1121798Medicaid