Provider Demographics
NPI:1356306245
Name:LUTHERAN BRETHREN RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:LUTHERAN BRETHREN RETIREMENT SERVICES, INC.
Other - Org Name:ALCOTT MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-998-7300
Mailing Address - Street 1:418 E ALCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2957
Mailing Address - Country:US
Mailing Address - Phone:218-998-7400
Mailing Address - Fax:
Practice Address - Street 1:418 E ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2957
Practice Address - Country:US
Practice Address - Phone:218-998-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN BRETHREN RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-20
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFBL001160712562310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility