1598000465 NPI number — LUTHERAN BRETHREN WOODLAND LODGE, 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 1598000465 NPI number — LUTHERAN BRETHREN WOODLAND LODGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN BRETHREN WOODLAND LODGE, 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:
1598000465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
824 S SHERIDAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUS FALLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56537-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-998-1400
Provider Business Mailing Address Fax Number:
218-998-7350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
394 WOODLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERGUS FALLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56537-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-998-1400
Provider Business Practice Location Address Fax Number:
218-998-7350
Provider Enumeration Date:
12/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROGNESS
Authorized Official First Name:
LELAND
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BOARD CHAIR/PRESIDENT
Authorized Official Telephone Number:
218-737-6148

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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