Provider Demographics
NPI:1023187507
Name:LUTHERAN SERVICES IN IOWA
Entity Type:Organization
Organization Name:LUTHERAN SERVICES IN IOWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-271-7388
Mailing Address - Street 1:3125 COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3809
Mailing Address - Country:US
Mailing Address - Phone:515-277-4476
Mailing Address - Fax:515-271-7450
Practice Address - Street 1:3125 COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-3809
Practice Address - Country:US
Practice Address - Phone:515-277-4476
Practice Address - Fax:515-271-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0077586Medicaid
IA0012476Medicaid