Provider Demographics
NPI:1952443780
Name:CHILDSERVE HOMES INC.
Entity Type:Organization
Organization Name:CHILDSERVE HOMES INC.
Other - Org Name:CHILDSERVE KEYSTONE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-1468
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-0707
Mailing Address - Country:US
Mailing Address - Phone:515-727-8750
Mailing Address - Fax:515-727-8757
Practice Address - Street 1:10350 STONE RIDGE ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2303
Practice Address - Country:US
Practice Address - Phone:515-986-0554
Practice Address - Fax:515-986-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA771149315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0882118Medicaid