Healthcare Provider Details

I. General information

NPI: 1215001995
Provider Name (Legal Business Name): TRINITY CENTER AT LUTHER PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HULL AVE
DES MOINES IA
50316-1341
US

IV. Provider business mailing address

1555 HULL AVE
DES MOINES IA
50316-1341
US

V. Phone/Fax

Practice location:
  • Phone: 515-262-5639
  • Fax: 515-266-8302
Mailing address:
  • Phone: 515-262-5639
  • Fax: 515-266-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number770825
License Number StateIA

VIII. Authorized Official

Name: MS. LORRIE LITTLE
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 515-262-5639