Provider Demographics
NPI:1215001995
Name:TRINITY CENTER AT LUTHER PARK
Entity Type:Organization
Organization Name:TRINITY CENTER AT LUTHER PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-262-5639
Mailing Address - Street 1:1555 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-1341
Mailing Address - Country:US
Mailing Address - Phone:515-262-5639
Mailing Address - Fax:515-266-8302
Practice Address - Street 1:1555 HULL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1341
Practice Address - Country:US
Practice Address - Phone:515-262-5639
Practice Address - Fax:515-266-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA770825311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802306Medicaid