1174510325 NPI number — LUTHERCARE

Table of content: (NPI 1174510325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174510325 NPI number — LUTHERCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERCARE
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:
LUTHER ACRES MANOR
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:
1174510325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 EAST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITITZ
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17543-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-626-1171
Provider Business Mailing Address Fax Number:
717-626-4390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SAINT LUKE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITITZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17543-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-626-6884
Provider Business Practice Location Address Fax Number:
717-626-4390
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCALOOSE
Authorized Official First Name:
CARL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
717-626-1171

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  122402 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1001260410031 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com