Basic Information
| Provider Information | |||||||||
| NPI: | 1831313956 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAFAYETTE LIFEPLANS OF HIAWATHA INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MAPLE HEIGHTS NURSING & REHABILIATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 302 EAST IOWA | ||||||||
| Address2: | |||||||||
| City: | HIAWATHA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857427465 | ||||||||
| FaxNumber: | 7857423979 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 E IOWA ST | ||||||||
| Address2: | |||||||||
| City: | HIAWATHA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664349826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857427465 | ||||||||
| FaxNumber: | 7857423979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DURYEA | ||||||||
| AuthorizedOfficialFirstName: | LESA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7857427465 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LACHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N007005 | KS | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.