Provider Demographics
NPI:1689376147
Name:LUTHERAN GOOD SHEPHERD HOME
Entity Type:Organization
Organization Name:LUTHERAN GOOD SHEPHERD HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LNHA, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:660-463-2267
Mailing Address - Street 1:202 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-9643
Mailing Address - Country:US
Mailing Address - Phone:660-463-2267
Mailing Address - Fax:
Practice Address - Street 1:202 S WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-9643
Practice Address - Country:US
Practice Address - Phone:660-463-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility