Provider Demographics
NPI:1245443928
Name:EHLERS LANE LC
Entity type:Organization
Organization Name:EHLERS LANE LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:SW
Authorized Official - Phone:563-652-2125
Mailing Address - Street 1:205 EHLERS LN
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-9615
Mailing Address - Country:US
Mailing Address - Phone:563-652-2125
Mailing Address - Fax:563-652-0145
Practice Address - Street 1:205 EHLERS LN
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-9615
Practice Address - Country:US
Practice Address - Phone:563-652-2125
Practice Address - Fax:563-652-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0078310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0275073Medicaid