1396888236 NPI number — SIOUXLAND RESIDENTIAL SERVICES INC

Table of content: (NPI 1396888236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396888236 NPI number — SIOUXLAND RESIDENTIAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIOUXLAND RESIDENTIAL SERVICES 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:
Provider Other Organization Name Type Code:
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:
1396888236
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 1047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51102-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-234-1055
Provider Business Mailing Address Fax Number:
712-234-0574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 PIERCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-234-1055
Provider Business Practice Location Address Fax Number:
712-234-0574
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIXNER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
712-234-1055

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  970952 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970988 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970984 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970948 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970953 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970971 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3104A0625X , with the licence number: 970977 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0896878 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0896860 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0245795 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0894139 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0894147 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0894113 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0896928 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0894121 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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