Provider Demographics
NPI:1578746699
Name:LUTHERAN HOME- ALBEMARLE, INC
Entity Type:Organization
Organization Name:LUTHERAN HOME- ALBEMARLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-982-8191
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0308
Mailing Address - Country:US
Mailing Address - Phone:704-982-8191
Mailing Address - Fax:704-983-1118
Practice Address - Street 1:24724 US HIGHWAY 52 S
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8179
Practice Address - Country:US
Practice Address - Phone:704-982-8191
Practice Address - Fax:704-983-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0140313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0313190002Medicare NSC
NC5329550001Medicare NSC