Provider Demographics
NPI:1003007063
Name:LAFAYETTE LIFEPLANS OF HIAWATHA, INC.
Entity Type:Organization
Organization Name:LAFAYETTE LIFEPLANS OF HIAWATHA, INC.
Other - Org Name:MAPLE HEIGHTS NURSING AND REHABILITATION CENTER OF HIAWATHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:3000 OLD ALABAMA RD
Mailing Address - Street 2:BOX 119-149
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5860
Mailing Address - Country:US
Mailing Address - Phone:770-619-0866
Mailing Address - Fax:
Practice Address - Street 1:302 E. IOWA STREET
Practice Address - Street 2:RR 2 E. IOWA STREET
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-9802
Practice Address - Country:US
Practice Address - Phone:785-742-2149
Practice Address - Fax:785-742-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
175508Medicare Oscar/Certification