Provider Demographics
NPI:1508850512
Name:MARTIN LUTHER HOME CORPORATION
Entity Type:Organization
Organization Name:MARTIN LUTHER HOME CORPORATION
Other - Org Name:LUTHER MANOR RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-690-6628
Mailing Address - Street 1:3131 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3908
Mailing Address - Country:US
Mailing Address - Phone:563-588-1413
Mailing Address - Fax:563-588-2770
Practice Address - Street 1:3131 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:563-588-1413
Practice Address - Fax:563-588-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
IANF-452311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No253Z00000XAgenciesIn Home Supportive Care
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802280Medicaid
165513Medicare Oscar/Certification