Basic Information
| Provider Information | |||||||||
| NPI: | 1003007063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAFAYETTE LIFEPLANS OF HIAWATHA, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAPLE HEIGHTS NURSING AND REHABILITATION CENTER OF HIAWATHA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 OLD ALABAMA RD | ||||||||
| Address2: | BOX 119-149 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300225860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706190866 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 302 E. IOWA STREET | ||||||||
| Address2: | RR 2 E. IOWA STREET | ||||||||
| City: | HIAWATHA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664349802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857422149 | ||||||||
| FaxNumber: | 7857423979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 06/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | MITTLEIDER | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7706190866 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.