Basic Information
| Provider Information | |||||||||
| NPI: | 1124188974 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IOWA JEWISH SENIOR LIFE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 POLK BLVD | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503122225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152555433 | ||||||||
| FaxNumber: | 5152778898 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 POLK BLVD | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503122225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152555433 | ||||||||
| FaxNumber: | 5152778898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | WIESE | ||||||||
| AuthorizedOfficialFirstName: | MARLENE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5152555433 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | IA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.