Provider Demographics
NPI:1639520034
Name:LUTHER OAKS INC
Entity Type:Organization
Organization Name:LUTHER OAKS INC
Other - Org Name:LUTHERAN SENIOR LIVING OF ILLINOIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-368-7300
Mailing Address - Street 1:601 LUTZ RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8608
Mailing Address - Country:US
Mailing Address - Phone:309-664-5940
Mailing Address - Fax:309-664-5999
Practice Address - Street 1:601 LUTZ RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8608
Practice Address - Country:US
Practice Address - Phone:309-664-5940
Practice Address - Fax:309-664-5999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN LIFE MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility