Provider Demographics
NPI:1770653867
Name:LUTHERAN HOME FOR THE AGED ASSOCIATION-EAST
Entity Type:Organization
Organization Name:LUTHERAN HOME FOR THE AGED ASSOCIATION-EAST
Other - Org Name:VINTON LUTHERAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-472-4211
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-0559
Mailing Address - Country:US
Mailing Address - Phone:319-472-4211
Mailing Address - Fax:319-472-2256
Practice Address - Street 1:1301 2ND AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-1638
Practice Address - Country:US
Practice Address - Phone:319-472-4211
Practice Address - Fax:319-472-2256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN HOME FOR THE AGED ASSOCIATION-EAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA820211314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802322Medicaid
IA165552Medicare Oscar/Certification