Provider Demographics
NPI:1760460489
Name:AMERICAN LUTHERAN CHURCH
Entity Type:Organization
Organization Name:AMERICAN LUTHERAN CHURCH
Other - Org Name:SALEM LUTHERAN HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAYE NAE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3100
Mailing Address - Street 1:2027 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:ELK HORN
Mailing Address - State:IA
Mailing Address - Zip Code:51531-8007
Mailing Address - Country:US
Mailing Address - Phone:712-764-4201
Mailing Address - Fax:712-764-4206
Practice Address - Street 1:2027 COLLEGE
Practice Address - Street 2:
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531-0703
Practice Address - Country:US
Practice Address - Phone:712-764-4201
Practice Address - Fax:712-764-4206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN LUTHERAN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-03
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA830061313M00000X
332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803551Medicaid
IA65155OtherBC/BS THERAPY AND CI
IA0803551Medicaid
IA1316740001Medicare NSC