Provider Demographics
NPI:1184629925
Name:LUTHER HAVEN
Entity Type:Organization
Organization Name:LUTHER HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FLAHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-269-6517
Mailing Address - Street 1:1109 E HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1711
Mailing Address - Country:US
Mailing Address - Phone:320-269-6517
Mailing Address - Fax:320-269-6510
Practice Address - Street 1:1109 E HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1711
Practice Address - Country:US
Practice Address - Phone:320-269-6517
Practice Address - Fax:320-269-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN388169314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245259Medicare ID - Type Unspecified