Provider Demographics
NPI:1639173362
Name:LUTHERAN HOMES OF MICHIGAN, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF MICHIGAN, INC.
Other - Org Name:LUTHERAN HOME-FRANKENMUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STORMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-262-7389
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:
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:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI734130314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2082631Medicaid
MIO 9648OtherBCBS INS. PROVIDER #
MI2082631Medicaid