Organization
ON WITH LIFE EXTENDED SERVICES, LTD.
Active
Other names
ON WITH LIFE LONG TERM CARE
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN LUFT-WISKUS (CREDENTIALING COORDINATOR)
(515) 289-9703
Entity
Organization
Contact information
Practice address
1002 W WASHINGTON AVE, POLK CITY, IA 50226-2132
(515) 289-9600
Mailing address
715 SW ANKENY RD, ANKENY, IA 50023-9798
(515) 965-1339
(515) 965-1186
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
650726
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0652818
—
IA
05
—
599-00
—
IA
01
—
65281
BLUE CROSS BLUE SHIELD
IA
Enumeration date
12/22/2006
Last updated
07/17/2024
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