Provider Demographics
NPI:1871516252
Name:LUTHERAN SERVICES IN IOWA, INC.
Entity type:Organization
Organization Name:LUTHERAN SERVICES IN IOWA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-633-3062
Mailing Address - Street 1:3116 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3845
Mailing Address - Country:US
Mailing Address - Phone:515-277-1658
Mailing Address - Fax:515-271-7453
Practice Address - Street 1:3116 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3845
Practice Address - Country:US
Practice Address - Phone:515-277-1658
Practice Address - Fax:515-271-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672402Medicaid
IA0672402Medicaid