Provider Demographics
NPI:1598000465
Name:LUTHERAN BRETHREN WOODLAND LODGE, INC.
Entity Type:Organization
Organization Name:LUTHERAN BRETHREN WOODLAND LODGE, INC.
Other - Org Name:LB WOODLAND LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-737-6148
Mailing Address - Street 1:824 S SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-3022
Mailing Address - Country:US
Mailing Address - Phone:218-998-1400
Mailing Address - Fax:218-998-7350
Practice Address - Street 1:394 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4644
Practice Address - Country:US
Practice Address - Phone:218-998-1400
Practice Address - Fax:218-998-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility