Provider Demographics
NPI:1609870286
Name:LUTHERAN HOMES OF MICHIGAN, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF MICHIGAN, INC.
Other - Org Name:LUTHERAN HOME-FRANKENMUTH-HOME FOR AGED
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 1:725 W GENESEE ST
Practice Address - Street 2:HOME FOR THE AGED
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1316
Practice Address - Country:US
Practice Address - Phone:989-652-9951
Practice Address - Fax:989-652-0339
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
MIAH 730236833310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO 9648OtherBCBS PROVIDER #
MI23-5269Medicare ID - Type UnspecifiedMEDICARE PART B BILLINGS