Provider Demographics
NPI:1811019870
Name:THE LUTHERAN HOME COCHRANE
Entity Type:Organization
Organization Name:THE LUTHERAN HOME COCHRANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:608-248-2658
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COCHRANE
Mailing Address - State:WI
Mailing Address - Zip Code:54622-7251
Mailing Address - Country:US
Mailing Address - Phone:608-248-2658
Mailing Address - Fax:608-248-2658
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COCHRANE
Practice Address - State:WI
Practice Address - Zip Code:54622-7251
Practice Address - Country:US
Practice Address - Phone:608-248-2658
Practice Address - Fax:608-248-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICBRF817310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICBRF817OtherWI DEPT OF HEALTH