Provider Demographics
NPI:1407989817
Name:THE LUTHERAN HOME CEDAR HAVEN
Entity Type:Organization
Organization Name:THE LUTHERAN HOME CEDAR HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:INGLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-873-6000
Mailing Address - Street 1:630-640 REED STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-625-1512
Mailing Address - Fax:507-388-6428
Practice Address - Street 1:630-640 REED STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-1512
Practice Address - Fax:507-388-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333375310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility