Provider Demographics
NPI:1124202759
Name:LUTHERAN HOME - HICKORY WEST
Entity Type:Organization
Organization Name:LUTHERAN HOME - HICKORY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-6995
Mailing Address - Street 1:1125 10TH STREET BLVD NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3373
Mailing Address - Country:US
Mailing Address - Phone:828-322-6995
Mailing Address - Fax:828-485-0070
Practice Address - Street 1:1125 10TH STREET BLVD NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3373
Practice Address - Country:US
Practice Address - Phone:828-322-6995
Practice Address - Fax:828-485-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0162314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5325960001Medicare NSC