Provider Demographics
NPI:1235243742
Name:SPIRITRUST LUTHERAN
Entity Type:Organization
Organization Name:SPIRITRUST LUTHERAN
Other - Org Name:SPIRITRUST LUTHERAN THE VILLAGE AT SHREWSBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-854-3971
Mailing Address - Street 1:1050 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1983
Mailing Address - Country:US
Mailing Address - Phone:717-854-3971
Mailing Address - Fax:717-854-6808
Practice Address - Street 1:200 LUTHER RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1726
Practice Address - Country:US
Practice Address - Phone:717-334-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA970902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001664120010Medicaid
395438Medicare Oscar/Certification