Provider Demographics
NPI:1467948380
Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Entity Type:Organization
Organization Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Other - Org Name:THE CLINIC AT LUTHER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KEUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-464-6396
Mailing Address - Street 1:4545 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4807
Mailing Address - Country:US
Mailing Address - Phone:414-464-6396
Mailing Address - Fax:
Practice Address - Street 1:4545 N 92ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53225-4807
Practice Address - Country:US
Practice Address - Phone:414-464-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center