=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831313956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAFAYETTE LIFEPLANS OF HIAWATHA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 E IOWA ST
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66434-9826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-742-7465
-----------------------------------------------------
Fax | 785-742-3979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 EAST IOWA
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-742-7465
-----------------------------------------------------
Fax | 785-742-3979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LESA A DURYEA
-----------------------------------------------------
Credential | LACHA
-----------------------------------------------------
Telephone | 785-742-7465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | N007005
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------