Provider Demographics
NPI:1942350798
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:CEDAR RAPIDS CREST SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUDGET & FINANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-331-1200
Mailing Address - Street 1:120 3RD AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5733
Mailing Address - Country:US
Mailing Address - Phone:319-364-6774
Mailing Address - Fax:319-364-3925
Practice Address - Street 1:120 3RD AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5733
Practice Address - Country:US
Practice Address - Phone:319-364-6774
Practice Address - Fax:319-364-3925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0121798Medicaid
IA0892240OtherSSA VENDOR #