Provider Demographics
NPI:1124875091
Name:ON WITH LIFE EXTENDED SERVICES, LTD.
Entity type:Organization
Organization Name:ON WITH LIFE EXTENDED SERVICES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUFT-WISKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-289-9703
Mailing Address - Street 1:715 SW ANKENY RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5999
Mailing Address - Country:US
Mailing Address - Phone:515-289-9600
Mailing Address - Fax:
Practice Address - Street 1:1002 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2132
Practice Address - Country:US
Practice Address - Phone:515-289-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric