Provider Demographics
NPI:1639173214
Name:LUTHERAN HOMES OF MICHIGAN INC
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF MICHIGAN INC
Other - Org Name:LUTHERAN HOME-MONROE 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:PO 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 1:1236 S MONROE STREET
Practice Address - Street 2:HOME FOR THE AGED
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3998
Practice Address - Country:US
Practice Address - Phone:734-241-9533
Practice Address - Fax:734-241-9108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO 9665OtherBCBS INS. PROVIDER #
MI23-5274Medicare ID - Type UnspecifiedPART B BILLINGS