Provider Demographics
NPI:1407986375
Name:ON WITH LIFE, INC.
Entity Type:Organization
Organization Name:ON WITH LIFE, INC.
Other - Org Name:ON WITH LIFE COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-289-9658
Mailing Address - Street 1:715 SW ANKENY RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9798
Mailing Address - Country:US
Mailing Address - Phone:515-965-1339
Mailing Address - Fax:515-965-1186
Practice Address - Street 1:715 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-965-1339
Practice Address - Fax:515-965-1186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ON WITH LIFE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0151043Medicaid