Provider Demographics
NPI:1568865970
Name:LUTHERAN LIFE VILLAGES HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:LUTHERAN LIFE VILLAGES HOME HEALTHCARE INC
Other - Org Name:LUTHERAN LIFE VILLAGES THE VILLAGES AT BIRCHWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-447-0800
Mailing Address - Street 1:8151 GLENCARIN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5799
Mailing Address - Country:US
Mailing Address - Phone:260-432-0011
Mailing Address - Fax:
Practice Address - Street 1:8151 GLENCARIN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5799
Practice Address - Country:US
Practice Address - Phone:260-432-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201054720AMedicaid
IN201054720BMedicaid