Provider Demographics
NPI:1497736268
Name:LUTHERAN CARE CENTER
Entity Type:Organization
Organization Name:LUTHERAN CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-483-6136
Mailing Address - Street 1:702 W CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-1053
Mailing Address - Country:US
Mailing Address - Phone:618-483-6136
Mailing Address - Fax:618-483-5607
Practice Address - Street 1:702 W CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1053
Practice Address - Country:US
Practice Address - Phone:618-483-6136
Practice Address - Fax:618-483-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X
IL0025023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0025023OtherLONG TERM CARE LICENSE
ILIL6005599Medicaid
ILIL6005599Medicaid