Provider Demographics
NPI:1790772341
Name:LEXINGTON SQUARE LLC
Entity Type:Organization
Organization Name:LEXINGTON SQUARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-524-5321
Mailing Address - Street 1:500 MESSENGER ROAD
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-2117
Mailing Address - Country:US
Mailing Address - Phone:319-524-5321
Mailing Address - Fax:
Practice Address - Street 1:500 MESSENGER ROAD
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2117
Practice Address - Country:US
Practice Address - Phone:319-524-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0809624Medicaid
IA0809624Medicaid
IA165151Medicare PIN