Provider Demographics
NPI:1376676908
Name:LUTHERAN HOME BELLE PLAINE LLC
Entity type:Organization
Organization Name:LUTHERAN HOME BELLE PLAINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MEGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:952-873-4758
Mailing Address - Street 1:611 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1221
Mailing Address - Country:US
Mailing Address - Phone:952-873-2142
Mailing Address - Fax:952-873-2147
Practice Address - Street 1:611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-1221
Practice Address - Country:US
Practice Address - Phone:952-873-2143
Practice Address - Fax:952-873-2147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LUTHERAN HOME ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334809315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN192045600Medicaid