Provider Demographics
NPI:1225224413
Name:FAITH HOME ASSISTED LIVING CORPORATION
Entity Type:Organization
Organization Name:FAITH HOME ASSISTED LIVING CORPORATION
Other - Org Name:FAITH HOME ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-732-5511
Mailing Address - Street 1:912 DAVIDSON DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1474
Mailing Address - Country:US
Mailing Address - Phone:641-832-2580
Mailing Address - Fax:641-832-2582
Practice Address - Street 1:912 DAVIDSON DR
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1474
Practice Address - Country:US
Practice Address - Phone:641-832-2580
Practice Address - Fax:641-832-2582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH LUTHERAN HOME CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0231310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility