Provider Demographics
NPI:1396888236
Name:SIOUXLAND RESIDENTIAL SERVICES INC
Entity type:Organization
Organization Name:SIOUXLAND RESIDENTIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:RIXNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-234-1055
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1047
Mailing Address - Country:US
Mailing Address - Phone:712-234-1055
Mailing Address - Fax:712-234-0574
Practice Address - Street 1:1815 PIERCE STREET
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105
Practice Address - Country:US
Practice Address - Phone:712-234-1055
Practice Address - Fax:712-234-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA9709523104A0625X
IA9709883104A0625X
IA9709843104A0625X
IA9709483104A0625X
IA9709533104A0625X
IA9709713104A0625X
IA9709773104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0896878Medicaid
IA0896860Medicaid
IA0245795Medicaid
IA0894139Medicaid
IA0894147Medicaid
IA0894113Medicaid
IA0896928Medicaid
IA0894121Medicaid