Provider Demographics
NPI:1790321255
Name:LUTHERDALE BIBLE CAMP, INC.
Entity Type:Organization
Organization Name:LUTHERDALE BIBLE CAMP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-742-2352
Mailing Address - Street 1:N7891 US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-2465
Mailing Address - Country:US
Mailing Address - Phone:262-742-2352
Mailing Address - Fax:888-248-4551
Practice Address - Street 1:N7891 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-2465
Practice Address - Country:US
Practice Address - Phone:262-742-2352
Practice Address - Fax:888-248-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp