Provider Demographics
NPI:1942310347
Name:THE LUTHERAN HOME
Entity Type:Organization
Organization Name:THE LUTHERAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHELLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-346-3344
Mailing Address - Street 1:530 S 26TH ST.
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105
Mailing Address - Country:US
Mailing Address - Phone:402-346-3344
Mailing Address - Fax:402-346-1967
Practice Address - Street 1:530 S 26TH ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-346-3344
Practice Address - Fax:402-346-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH00621OtherBLUE CROSS BLUE SHIELD
NE71-00090OtherUNITED HEALTH CARE
NEH00621OtherBLUE CROSS BLUE SHIELD
NEH00621OtherBLUE CROSS BLUE SHIELD