Provider Demographics
NPI:1326035577
Name:LUTHERCARE
Entity Type:Organization
Organization Name:LUTHERCARE
Other - Org Name:SPANG CREST MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCALOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-626-1171
Mailing Address - Street 1:600 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-2224
Mailing Address - Country:US
Mailing Address - Phone:717-626-1171
Mailing Address - Fax:717-626-1610
Practice Address - Street 1:945 DUKE STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7216
Practice Address - Country:US
Practice Address - Phone:717-274-1495
Practice Address - Fax:717-274-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA193602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001260410029Medicaid
PA1001260410029Medicaid