Provider Demographics
NPI:1316372253
Name:THOMPSON & THOMPSON LONG TERM CARE INC
Entity Type:Organization
Organization Name:THOMPSON & THOMPSON LONG TERM CARE INC
Other - Org Name:RELIANT LTC OF DES MOINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:319-330-4328
Mailing Address - Street 1:1010 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1624
Mailing Address - Country:US
Mailing Address - Phone:319-653-1043
Mailing Address - Fax:888-653-1063
Practice Address - Street 1:3520 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4359
Practice Address - Country:US
Practice Address - Phone:515-279-2062
Practice Address - Fax:888-653-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142024OtherPK
IA1316372253Medicaid