Provider Demographics
NPI:1376686766
Name:CEDAR FALLS LUTHERAN HOME
Entity Type:Organization
Organization Name:CEDAR FALLS LUTHERAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL RECORDS SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-553-2211
Mailing Address - Street 1:7511 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5027
Mailing Address - Country:US
Mailing Address - Phone:319-268-0401
Mailing Address - Fax:319-268-0040
Practice Address - Street 1:7511 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5027
Practice Address - Country:US
Practice Address - Phone:319-268-0401
Practice Address - Fax:314-268-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
IA070154314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165465Medicare Oscar/Certification