Provider Demographics
NPI:1518961192
Name:LUTHERAN HOMES OF MICHIGAN, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF MICHIGAN, INC.
Other - Org Name:LUTHERAN HOME-LIVONIA-SPECIAL CARE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-652-3470
Mailing Address - Street 1:9710 JUNCTION RD
Mailing Address - Street 2:P.O. BOX 329
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-0329
Mailing Address - Country:US
Mailing Address - Phone:989-652-3470
Mailing Address - Fax:989-652-3480
Practice Address - Street 1:28910 PLYMOUTH RD
Practice Address - Street 2:SPECIAL CARE UNIT
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2337
Practice Address - Country:US
Practice Address - Phone:734-425-4814
Practice Address - Fax:734-425-6024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN HOMES OF MICHIGAN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS 9505OtherBCBS INS. PROVIDER #
MI23-5587Medicare ID - Type UnspecifiedMEDICARE PART B BILLING