1487648598 NPI number — LUTHERAN HOMES

Table of content: (NPI 1487648598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487648598 NPI number — LUTHERAN HOMES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOMES
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:
1487648598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 480
Provider Second Line Business Mailing Address:
208 OPPEGARD AVE NW
Provider Business Mailing Address City Name:
TWIN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56584-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-584-5181
Provider Business Mailing Address Fax Number:
218-584-5304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 OPPEGARD AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56584-0480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-584-5181
Provider Business Practice Location Address Fax Number:
218-584-5304
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHREINER
Authorized Official First Name:
SHARI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
218-584-5181

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  328507 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 546242800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9751 LU . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 030221 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71-22703 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: NH 0586 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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