Provider Demographics
NPI:1316293624
Name:XIST LLC
Entity type:Organization
Organization Name:XIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAIBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-993-2123
Mailing Address - Street 1:707 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-1523
Mailing Address - Country:US
Mailing Address - Phone:515-993-2123
Mailing Address - Fax:515-993-2276
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1523
Practice Address - Country:US
Practice Address - Phone:515-993-2123
Practice Address - Fax:515-993-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0211394Medicaid
IA0109338Medicaid