1457357493 NPI number — THE LUTHERAN HOMES SOCIETY

Table of content: (NPI 1457357493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457357493 NPI number — THE LUTHERAN HOMES SOCIETY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LUTHERAN HOMES SOCIETY
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:
LUTHERAN LIVING SENIOR CAMPUS
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:
1457357493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2421 LUTHERAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSCATINE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52761-9382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-263-1241
Provider Business Mailing Address Fax Number:
563-263-4180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2421 LUTHERAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSCATINE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52761-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-263-1241
Provider Business Practice Location Address Fax Number:
563-263-4180
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BATENHORST
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD CHAIR
Authorized Official Telephone Number:
563-299-6438

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  S0121 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311500000X , with the licence number: N-428 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: N-428 , 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: 700428 , 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: N-428 , 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: 0802348 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65432 . This is a "BCBS OF IOWA PROVIDER NUM" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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