Healthcare Provider Details

I. General information

NPI: 1013904432
Provider Name (Legal Business Name): BARTELS LUTHERAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 5TH AVE NW
WAVERLY IA
50677-1903
US

IV. Provider business mailing address

1922 5TH AVE NW
WAVERLY IA
50677-1903
US

V. Phone/Fax

Practice location:
  • Phone: 319-352-4540
  • Fax: 319-352-2161
Mailing address:
  • Phone: 319-352-4540
  • Fax: 319-352-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number090286
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number090286
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA GEISE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 319-352-4540