Provider Demographics
NPI:1356343669
Name:MINNEWASKA LUTHERAN HOME
Entity type:Organization
Organization Name:MINNEWASKA LUTHERAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EHRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-239-7156
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0040
Mailing Address - Country:US
Mailing Address - Phone:320-239-2217
Mailing Address - Fax:320-239-2219
Practice Address - Street 1:605 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:FM
Practice Address - Zip Code:56381
Practice Address - Country:US
Practice Address - Phone:320-239-2217
Practice Address - Fax:320-239-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2023-10-20
Deactivation Date:2023-10-18
Deactivation Code:
Reactivation Date:2023-10-20
Provider Licenses
StateLicense IDTaxonomies
MN325202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN328542100Medicaid
MN245537Medicare ID - Type Unspecified