1194867655 NPI number — SKYLINE CENTER INC

Table of content: (NPI 1194867655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194867655 NPI number — SKYLINE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKYLINE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLINTON ASSOCIATION FOR DAYCARE OF HANDICAPPED CHILDREN
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194867655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52732-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-243-4065
Provider Business Mailing Address Fax Number:
563-243-9901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-243-4065
Provider Business Practice Location Address Fax Number:
563-243-9901
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
563-243-4065

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0243410 . This is a "ARO" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0228700 . This is a "ARO" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0672949 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com