Healthcare Provider Details

I. General information

NPI: 1831313956
Provider Name (Legal Business Name): LAFAYETTE LIFEPLANS OF HIAWATHA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E IOWA ST
HIAWATHA KS
66434-9826
US

IV. Provider business mailing address

302 EAST IOWA
HIAWATHA KS
66434
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-7465
  • Fax: 785-742-3979
Mailing address:
  • Phone: 785-742-7465
  • Fax: 785-742-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN007005
License Number StateKS

VIII. Authorized Official

Name: MRS. LESA A DURYEA
Title or Position: ADMINISTRATOR
Credential: LACHA
Phone: 785-742-7465