Provider Demographics
NPI:1194028118
Name:LUTHERAN HOME - WILMINGTON, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOME - WILMINGTON, INC.
Other - Org Name:TRINITY GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-637-2870
Mailing Address - Street 1:1416 S MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:PO BOX 947
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5592
Mailing Address - Country:US
Mailing Address - Phone:704-637-2870
Mailing Address - Fax:910-799-6564
Practice Address - Street 1:631 JUNCTION CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2296
Practice Address - Country:US
Practice Address - Phone:910-465-6861
Practice Address - Fax:910-799-6564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SERVICES FOR THE AGING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-14
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility