=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548891567
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LCS COMMUNITY EMPLOYMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2020
-----------------------------------------------------
Last Update Date | 01/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 LOCUST ST STE 820
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50309-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-875-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 LOCUST ST STE 820
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50309-2334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP/CONTROLLER/TREASURER
-----------------------------------------------------
Name | JASON VICTOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-875-4619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------