1053338566 NPI number — STRAWBERRY POINT LUTHERAN HOME FOR THE AGED

Table of content: (NPI 1053338566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053338566 NPI number — STRAWBERRY POINT LUTHERAN HOME FOR THE AGED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAWBERRY POINT LUTHERAN HOME FOR THE AGED
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:
STRAWBERRY POINT LUTHERAN HOME
Provider Other Organization Name Type Code:
3
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:
1053338566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 ELKADER ST.
Provider Second Line Business Mailing Address:
P.O. BOX 34
Provider Business Mailing Address City Name:
STRAWBERRY PT.
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52076-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-933-6037
Provider Business Mailing Address Fax Number:
563-933-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 ELKADER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRAWBERRY PT.
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52076-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-933-6037
Provider Business Practice Location Address Fax Number:
563-933-2204
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEFFEN
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
563-933-6037

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , with the licence number:  220344 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X , with the licence number: 220344 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 220344 , 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: 36443546 . This is a "VETERANS ADMINSTRATION" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0802314 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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