Provider Demographics
NPI:1285633743
Name:THE LUTHERAN HOME, INC.
Entity Type:Organization
Organization Name:THE LUTHERAN HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-258-6171
Mailing Address - Street 1:7500 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1717
Mailing Address - Country:US
Mailing Address - Phone:414-258-6170
Mailing Address - Fax:414-777-1723
Practice Address - Street 1:7500 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1717
Practice Address - Country:US
Practice Address - Phone:414-258-6170
Practice Address - Fax:414-777-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
WI293314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20129800Medicaid
WI525545Medicare ID - Type UnspecifiedMEDICARE