Provider Demographics
NPI:1699389346
Name:PERRY LUTHERAN HOME - ROWLEY CAMPUS LLC
Entity Type:Organization
Organization Name:PERRY LUTHERAN HOME - ROWLEY CAMPUS LLC
Other - Org Name:PERRY LUTHERAN HOMES EDEN ACRES CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-465-5342
Mailing Address - Street 1:2323 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-2148
Mailing Address - Country:US
Mailing Address - Phone:515-465-5342
Mailing Address - Fax:
Practice Address - Street 1:1300 28TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2329
Practice Address - Country:US
Practice Address - Phone:515-465-5342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility