Healthcare Provider Details

I. General information

NPI: 1396277273
Provider Name (Legal Business Name): MARTIN LUTHER HOME CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 GRAND MEADOW DR.
ASBURY IA
52002-9999
US

IV. Provider business mailing address

3131 HILLCREST RD
DUBUQUE IA
52001-3908
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-7662
  • Fax:
Mailing address:
  • Phone: 563-588-1413
  • Fax: 563-588-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number310452
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number310452
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number310452
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANET WARREN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-588-1413