Provider Demographics
NPI:1003522046
Name:LUTHERAN SENIOR SERVICES
Entity Type:Organization
Organization Name:LUTHERAN SENIOR SERVICES
Other - Org Name:CONCORDIA VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-446-2405
Mailing Address - Street 1:4101 W ILES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7051
Mailing Address - Country:US
Mailing Address - Phone:217-793-9429
Mailing Address - Fax:217-793-1333
Practice Address - Street 1:4101 W ILES AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7051
Practice Address - Country:US
Practice Address - Phone:217-793-9429
Practice Address - Fax:217-793-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility