Provider Demographics
NPI:1639339518
Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC.
Entity Type:Organization
Organization Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC.
Other - Org Name:LUTHER MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KEUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-464-6396
Mailing Address - Street 1:4545 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4807
Mailing Address - Country:US
Mailing Address - Phone:414-464-3880
Mailing Address - Fax:414-464-5834
Practice Address - Street 1:4545 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225
Practice Address - Country:US
Practice Address - Phone:414-464-3880
Practice Address - Fax:414-464-5834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-13
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0934311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20134000Medicaid
WI525588Medicare Oscar/Certification