Provider Demographics
NPI:1932253374
Name:HILLS AND DALES CHILD DEVELOPMENT CENTER
Entity type:Organization
Organization Name:HILLS AND DALES CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-556-7878
Mailing Address - Street 1:1011 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1306
Mailing Address - Country:US
Mailing Address - Phone:563-556-7878
Mailing Address - Fax:563-557-3822
Practice Address - Street 1:1011 DAVIS ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1306
Practice Address - Country:US
Practice Address - Phone:563-556-7878
Practice Address - Fax:563-557-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM3000X
IA310131320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0083840Medicaid