Provider Demographics
NPI:1245207307
Name:LUTHERAN HOME OF WORCESTER INC
Entity Type:Organization
Organization Name:LUTHERAN HOME OF WORCESTER INC
Other - Org Name:LUTHERAN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-754-8877
Mailing Address - Street 1:26 HARVARD ST
Mailing Address - Street 2:LUTHERAN HEALTHCARE CENTER OF WORCESTER
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2833
Mailing Address - Country:US
Mailing Address - Phone:508-754-8877
Mailing Address - Fax:508-754-7141
Practice Address - Street 1:26 HARVARD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2833
Practice Address - Country:US
Practice Address - Phone:508-754-8877
Practice Address - Fax:508-754-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
MA0121314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0940470Medicaid
MA0914436Medicaid
225379Medicare UPIN
MA225379Medicare Oscar/Certification