Provider Demographics
NPI:1366500134
Name:SPIRITRUST LUTHERAN
Entity Type:Organization
Organization Name:SPIRITRUST LUTHERAN
Other - Org Name:SPIRITRUST LUTHERAN THE VILLAGE AT LUTHER RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:2735 LUTHER DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-8131
Practice Address - Country:US
Practice Address - Phone:717-264-5700
Practice Address - Fax:717-264-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA352980310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility