Provider Demographics
NPI:1164423463
Name:LUTHERAN SUNSET HOME CORPORATION
Entity Type:Organization
Organization Name:LUTHERAN SUNSET HOME CORPORATION
Other - Org Name:LUTHERAN SUNSET HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-352-1901
Mailing Address - Street 1:333 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1233
Mailing Address - Country:US
Mailing Address - Phone:701-352-1901
Mailing Address - Fax:701-352-1926
Practice Address - Street 1:333 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1233
Practice Address - Country:US
Practice Address - Phone:701-352-1901
Practice Address - Fax:701-352-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDAL34310400000X
ND1026A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1636OtherBC/BS
ND30016Medicaid
ND1636OtherBC/BS