Provider Demographics
NPI:1679614754
Name:CHILDSERVE THERAPY, INC.
Entity type:Organization
Organization Name:CHILDSERVE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-727-1463
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 1:5406 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1209
Practice Address - Country:US
Practice Address - Phone:515-727-8750
Practice Address - Fax:515-727-8757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDSERVE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 225100000X, 235Z00000X
IA2251P0200X, 225200000X, 225X00000X, 225XP0200X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665091Medicaid
IA65443OtherCOVENTY
IA110061OtherHEALTH ALLIANCE
IA0120113Medicaid
IA640002508OtherRAILROAD MEDICARE
IAF245447OtherMIDLAND'S CHOICE
IA66509OtherBCBS OF IOWA
IA0120113Medicaid
IA0120113Medicaid