1053317735 NPI number — LUTHERAN HOME CARE AGENCY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317735 NPI number — LUTHERAN HOME CARE AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOME CARE AGENCY, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1053317735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MAYER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKENMUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48734-9502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-652-4663
Provider Business Mailing Address Fax Number:
989-652-3279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MAYER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKENMUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48734-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-652-4663
Provider Business Practice Location Address Fax Number:
989-652-3279
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MAURER
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
989-652-4663

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2937288 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OE079 . This is a "BCBS INS. PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0997626 . This is a "HEALTHPLUS INS.-PROVIDER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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