Provider Demographics
NPI:1396574257
Name:CENTER OF DEVELOPMENTAL DISABILITY LLC
Entity type:Organization
Organization Name:CENTER OF DEVELOPMENTAL DISABILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-880-9043
Mailing Address - Street 1:300 W BROADWAY STE 701
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9030
Mailing Address - Country:US
Mailing Address - Phone:402-880-9043
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY STE 701
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9030
Practice Address - Country:US
Practice Address - Phone:402-880-9043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care