Provider Demographics
NPI:1003246547
Name:LUTHERAN SENIORLIFE
Entity Type:Organization
Organization Name:LUTHERAN SENIORLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REHAB LUTHERAN SENIORLIFE
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-452-1603
Mailing Address - Street 1:400 .WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ZELIENUPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063
Mailing Address - Country:US
Mailing Address - Phone:724-452-3492
Mailing Address - Fax:
Practice Address - Street 1:400 WEST CULVERT STREET
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063
Practice Address - Country:US
Practice Address - Phone:724-452-3492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012054261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396794Medicare PIN