Provider Demographics
NPI:1841384997
Name:COLE COUNTY LUTHERAN HOME ASSOCIATION
Entity Type:Organization
Organization Name:COLE COUNTY LUTHERAN HOME ASSOCIATION
Other - Org Name:HEISINGER LUTHERAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-446-2405
Mailing Address - Street 1:1150 HANLEY INDUSTRIAL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1910
Mailing Address - Country:US
Mailing Address - Phone:314-968-9313
Mailing Address - Fax:314-968-5590
Practice Address - Street 1:1002 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6901
Practice Address - Country:US
Practice Address - Phone:573-636-6288
Practice Address - Fax:573-636-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031188314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106118508Medicaid
MO106118508Medicaid