Provider Demographics
NPI:1235225699
Name:IOWA JEWISH SENIOR LIFE CENTER
Entity Type:Organization
Organization Name:IOWA JEWISH SENIOR LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-255-5433
Mailing Address - Street 1:900 POLK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2225
Mailing Address - Country:US
Mailing Address - Phone:515-255-5433
Mailing Address - Fax:515-277-8898
Practice Address - Street 1:900 POLK BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2225
Practice Address - Country:US
Practice Address - Phone:515-255-5433
Practice Address - Fax:515-277-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS384313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802025Medicaid
165006Medicare ID - Type Unspecified