Provider Demographics
NPI:1598988743
Name:LEE WOLF
Entity Type:Organization
Organization Name:LEE WOLF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-883-2893
Mailing Address - Street 1:4066 320TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51034-8005
Mailing Address - Country:US
Mailing Address - Phone:712-883-2893
Mailing Address - Fax:712-883-2894
Practice Address - Street 1:4066 320TH ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:IA
Practice Address - Zip Code:51034-8005
Practice Address - Country:US
Practice Address - Phone:712-883-2893
Practice Address - Fax:712-883-2894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0479691Medicaid