Provider Demographics
NPI:1730104415
Name:LUTHERAN CARE CENTER INC
Entity Type:Organization
Organization Name:LUTHERAN CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-9211
Mailing Address - Street 1:1200 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3309
Mailing Address - Country:US
Mailing Address - Phone:320-632-9211
Mailing Address - Fax:320-632-2097
Practice Address - Street 1:1200 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3309
Practice Address - Country:US
Practice Address - Phone:320-632-9211
Practice Address - Fax:320-632-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331606314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9617LUOtherBLUE CROSS BLUE SHIELD
MN615542100Medicaid
MN71-22644OtherMEDICA
MN71-22644OtherMEDICA