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NPI Code Detail

MEDICARE: ON WITH LIFE EXTENDED SERVICES, LTD.

MEDICARE: ON WITH LIFE EXTENDED SERVICES, LTD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13140N1450XPediatric Skilled Nursing Facility650726IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
265281OTHERIABLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841355575
Entity Type Code : Organization
Provider Name (Legal Business Name) : ON WITH LIFE EXTENDED SERVICES, LTD.
Provider Business Mailing Address
First Line : 715 SW ANKENY RD
Second Line :
City : ANKENY
State : IA
Zip : 50023-9798
Country : US
Telephone Number : 515-965-1339
Fax Number : 515-965-1186
Provider Business Practice Location Address
First Line : 1002 W WASHINGTON AVE
Second Line :
City : POLK CITY
State : IA
Zip : 50226-2132
Country : US
Telephone Number : 515-289-9600
Fax Number :
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : ERIN LUFT-WISKUS
Credential :
Telephone Number : 515-289-9703
Provider Enumeration Date : 12/22/2006
Last Update Date : 07/17/2024

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Directions to “ON WITH LIFE EXTENDED SERVICES, LTD. ” Practice Location

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