Provider Demographics
NPI:1194712760
Name:ST LUKE HOMES & SERVICES INC
Entity type:Organization
Organization Name:ST LUKE HOMES & SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-262-5931
Mailing Address - Street 1:1301 SAINT LUKE DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-6043
Mailing Address - Country:US
Mailing Address - Phone:712-262-5931
Mailing Address - Fax:712-262-4743
Practice Address - Street 1:1301 SAINT LUKE DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-6043
Practice Address - Country:US
Practice Address - Phone:712-262-5931
Practice Address - Fax:712-262-4743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0158725310400000X
IA0803775313M00000X
IA165484314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803775Medicaid
IA0803775Medicaid