Provider Demographics
NPI:1972508141
Name:COLUMBIA LUTHERAN MINISTRIES
Entity Type:Organization
Organization Name:COLUMBIA LUTHERAN MINISTRIES
Other - Org Name:COLUMBIA LUTHERAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-632-7400
Mailing Address - Street 1:4700 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6374
Mailing Address - Country:US
Mailing Address - Phone:206-632-7400
Mailing Address - Fax:206-633-0589
Practice Address - Street 1:4700 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6374
Practice Address - Country:US
Practice Address - Phone:206-632-7400
Practice Address - Fax:206-633-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH48314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4104808Medicaid
WA578OtherPREMERA BLUE CROSS
WA505470Medicare ID - Type UnspecifiedMEDICARE PROVIDER #