Provider Demographics
NPI:1396277273
Name:MARTIN LUTHER HOME CORPORATION
Entity type:Organization
Organization Name:MARTIN LUTHER HOME CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-588-1413
Mailing Address - Street 1:3131 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3908
Mailing Address - Country:US
Mailing Address - Phone:563-588-1413
Mailing Address - Fax:563-588-3875
Practice Address - Street 1:5300 GRAND MEADOW DR.
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-9999
Practice Address - Country:US
Practice Address - Phone:563-557-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
IA310452310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility