Provider Demographics
NPI:1932475142
Name:TIPTON ADAPTIVE DAYCARE LLC
Entity Type:Organization
Organization Name:TIPTON ADAPTIVE DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:VANDERGAAST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:563-886-3143
Mailing Address - Street 1:118 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1349
Mailing Address - Country:US
Mailing Address - Phone:563-886-3143
Mailing Address - Fax:563-886-3143
Practice Address - Street 1:118 PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1349
Practice Address - Country:US
Practice Address - Phone:563-886-3143
Practice Address - Fax:563-886-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104423163W00000X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, ChildGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1023233806Medicaid