Provider Demographics
NPI:1467456434
Name:LUTHERAN HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOME CARE AGENCY, INC.
Other - Org Name:LUTHERAN HOME CARE - HOSPICE OF HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-652-4663
Mailing Address - Street 1:100 MAYER ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9502
Mailing Address - Country:US
Mailing Address - Phone:989-652-4663
Mailing Address - Fax:989-652-3279
Practice Address - Street 1:100 MAYER ROAD
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-9502
Practice Address - Country:US
Practice Address - Phone:989-652-4663
Practice Address - Fax:989-652-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI733513251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71010000008787OtherBCBS INS.-PROV #
MI0989890OtherHEALTH PLUS INS. - PROV #
MI4151424Medicaid
MI71010000008787OtherBCBS INS.-PROV #