=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023401916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN LUTHER HOME CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2015
-----------------------------------------------------
Last Update Date | 03/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 HILLCREST RD
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-588-1145
-----------------------------------------------------
Fax | 563-588-3875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 HILLCREST RD
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-588-1145
-----------------------------------------------------
Fax | 563-588-3875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LINDSAY EDE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 563-588-1145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------