Ehlers Lane LC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

S0078 Issued in IA

Legal business name

EHLERS LANE LC

Doing business as

Clover Ridge Place

Practice address

205 Ehlers LN
Maquoketa, IA 52060-9615

Phone

(563) 652-2125

Fax

(563) 652-0145

NPI assigned

May 8, 2007

Last updated

Jun 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lynne Popp, SW

Title

Manager

Phone

(563) 652-2125

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clover Ridge Place Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1245443928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 EHLERS LN",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520609615",
            "telephone_number": "563-652-2125",
            "fax_number": "563-652-0145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 EHLERS LN",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520609615",
            "telephone_number": "563-652-2125",
            "fax_number": "563-652-0145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EHLERS LANE LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "POPP",
        "authorized_official_first_name": "LYNNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "563-652-2125",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SW"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": "S0078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0275073",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clover Ridge Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Maquoketa, IA
• Providers in Maquoketa, IA by specialty
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.