Provider Demographics
NPI:1669463410
Name:LUTHERAN CENTER AT POUGHKEEPSIE, INC
Entity Type:Organization
Organization Name:LUTHERAN CENTER AT POUGHKEEPSIE, INC
Other - Org Name:LUTHERAN CENTER AT POUGHKEEPSIE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISGRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-235-8236
Mailing Address - Street 1:965 DUTCHESS TPKE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1551
Mailing Address - Country:US
Mailing Address - Phone:845-486-9494
Mailing Address - Fax:845-486-7592
Practice Address - Street 1:965 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1551
Practice Address - Country:US
Practice Address - Phone:845-486-9494
Practice Address - Fax:845-486-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302306N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897323Medicaid
NY1302306NOtherNYS DOH LICENSE NUMBER
NY335810Medicare ID - Type UnspecifiedMEDICARE NUMBER