Provider Demographics
NPI:1538135173
Name:LUTHER HOME OF MERCY INC.
Entity Type:Organization
Organization Name:LUTHER HOME OF MERCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WUKOTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-725-5226
Mailing Address - Street 1:5810 NORTH MAIN ST.
Mailing Address - Street 2:P O BOX 187
Mailing Address - City:WILLISTON
Mailing Address - State:OH
Mailing Address - Zip Code:43468
Mailing Address - Country:US
Mailing Address - Phone:419-725-5225
Mailing Address - Fax:419-836-9238
Practice Address - Street 1:5810 N MAIN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:OH
Practice Address - Zip Code:43468
Practice Address - Country:US
Practice Address - Phone:419-725-5225
Practice Address - Fax:419-836-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1575315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0035287Medicaid
OHM6200364Medicaid