Provider Demographics
NPI:1851353338
Name:LUTHERAN HOME FOR TH E AGED
Entity Type:Organization
Organization Name:LUTHERAN HOME FOR TH E AGED
Other - Org Name:LUTHERAN HOME HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:573-334-1515
Mailing Address - Street 1:2825 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6335
Mailing Address - Country:US
Mailing Address - Phone:573-334-1515
Mailing Address - Fax:
Practice Address - Street 1:2825 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6335
Practice Address - Country:US
Practice Address - Phone:573-334-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO134-2HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261599Medicare ID - Type UnspecifiedPROVIDER