Provider Demographics
NPI:1558359026
Name:IOLA LIVING ASSISTANCE, INC.
Entity Type:Organization
Organization Name:IOLA LIVING ASSISTANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LOESER
Authorized Official - Suffix:
Authorized Official - Credentials:MA NHA
Authorized Official - Phone:715-445-2412
Mailing Address - Street 1:185 S CHET KRAUSE DR
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9300
Mailing Address - Country:US
Mailing Address - Phone:715-445-2141
Mailing Address - Fax:
Practice Address - Street 1:185 S CHET KRAUSE DR
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9300
Practice Address - Country:US
Practice Address - Phone:715-445-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1199314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20150400Medicaid
WI20150400Medicaid