Organization Active NPI

On With Life Extended Services, LTD.

Doing business as On With Life Long Term Care

  • Pediatric Skilled Nursing Facility
  • Polk City, IA
National Provider Identifier
1841355575
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X
License
650726 Issued in IA
Legal business name
ON WITH LIFE EXTENDED SERVICES, LTD.
Doing business as
On With Life Long Term Care
Practice address
1002 W Washington Ave
Polk City, IA 50226-2132
Phone
(515) 289-9600
NPI assigned
Dec 22, 2006
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Erin Luft-Wiskus
Title
Credentialing Coordinator
Phone
(515) 289-9703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Skilled Nursing Facility 3140N1450X 650726 IA Primary

Addresses

Primary practice location

1002 W Washington Ave
Polk City, IA 50226-2132

Mailing address

715 SW Ankeny Rd
Ankeny, IA 50023-9798
Phone (515) 965-1339

Other identifiers 3

IdentifierTypeStateIssuer
599-00MedicaidIA
65281OtherIABLUE CROSS BLUE SHIELD
0652818MedicaidIA

Other names 1

  • ON WITH LIFE LONG TERM CARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111018000814 IA Part A Provider - Skilled Nursing Facility 0244402188 Practice locations: Polk City, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841355575. Details of each certification follow.

Skilled nursing facility certification: CCN 165281

Legal name
ON WITH LIFE EXTENDED SERVICES LTD
Doing business as
ON WITH LIFE LONG TERM CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 3, 1996
Last certification
Dec 12, 2024
Beds
40
Ownership / control type
Nonprofit Corporation
Multi-facility organization
On With Life, Inc.
Organization structure
CorporationNon-profit
Enrollment address
1002 W Washington Ave
Polk City, IA 50226-2132
Nursing home name
ON WITH LIFE LONG TERM CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
On With Life Long Term CareCCN 165281 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 3, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4039.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
On With Life Extended Services LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
On With Life Extended Services LTD Organization, Polk City, IA Corporation, Non-profit Operational/Managerial Control Jul 1, 2011 100%
John Snyder Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Jeanette a Shelton Individual Corporate OfficerCeo Nov 1, 2017 100%
Operational/Managerial Control Nov 1, 2017 100%
Jennifer Lewis Individual Operational/Managerial ControlAdministrator Jun 1, 2019 100%
On With Life Inc Organization, Ankeny, IA Corporation, Non-profit Operational/Managerial Control Jul 1, 2001
Jim Foreman Individual W-2 Managing Employee Jan 1, 2015 100%
Diana E Hoogestraat Individual Managing Control - Governing Body Jan 1, 2024
Indirect Ownership Interest Jan 1, 2024
Rudy Fors Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Indirect Ownership Interest Jan 1, 2024
Kate Benson Larson Individual Managing Control - Governing BodyBoard Member Jan 1, 2024

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1841355575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SW ANKENY RD",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500239798",
            "telephone_number": "515-965-1339",
            "fax_number": "515-965-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 W WASHINGTON AVE",
            "city": "POLK CITY",
            "state": "IA",
            "postal_code": "502262132",
            "telephone_number": "515-289-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON WITH LIFE EXTENDED SERVICES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "LUFT-WISKUS",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "515-289-9703"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "IA",
            "license": "650726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "599-00",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65281",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0652818",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ON WITH LIFE LONG TERM CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polk City, IA

Sources for this page

Verify at the official NPI Registry.