Healthcare Provider Details

I. General information

NPI: 1194712760
Provider Name (Legal Business Name): ST LUKE HOMES & SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SAINT LUKE DR
SPENCER IA
51301-6043
US

IV. Provider business mailing address

1301 SAINT LUKE DR
SPENCER IA
51301-6043
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-5931
  • Fax: 712-262-4743
Mailing address:
  • Phone: 712-262-5931
  • Fax: 712-262-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0158725
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0803775
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number165484
License Number StateIA

VIII. Authorized Official

Name: MR. ALAN B CAMPBELL
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 712-262-5931