Provider Demographics
NPI:1003811571
Name:GOOD SHEPHERD LUTHERAN HOME
Entity Type:Organization
Organization Name:GOOD SHEPHERD LUTHERAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-864-7714
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-0747
Mailing Address - Country:US
Mailing Address - Phone:507-864-7714
Mailing Address - Fax:507-864-2842
Practice Address - Street 1:800 HOME ST
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-8836
Practice Address - Country:US
Practice Address - Phone:507-864-7714
Practice Address - Fax:507-864-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0033469314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNH0287OtherUCARE OF MN
MIS5744OtherBLUE CROSS & BLUE SHEILD
MN4657G0OtherBLUE CROSS & BLUE SHEILD
MIS5744OtherBLUE CROSS & BLUE SHEILD