1033156914 NPI number — LUTHERAN ORPHANS AND OLD FOLKS HOME AT NAPOLEON

Table of content: (NPI 1033156914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033156914 NPI number — LUTHERAN ORPHANS AND OLD FOLKS HOME AT NAPOLEON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN ORPHANS AND OLD FOLKS HOME AT NAPOLEON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUTHERAN NURSING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033156914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 N MCCORD RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43615-3030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-861-4990
Provider Business Mailing Address Fax Number:
419-861-2710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1036 S PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPOLEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43545-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-592-1688
Provider Business Practice Location Address Fax Number:
419-599-4791
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHURTS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
419-861-4990

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  3561 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0581302 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000296493 . This is a "ANTHEM/BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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