Provider Demographics
NPI:1396727004
Name:LUTHERAN HOME OF THE GOOD SHEPHERD
Entity type:Organization
Organization Name:LUTHERAN HOME OF THE GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:NHAL
Authorized Official - Phone:701-947-2944
Mailing Address - Street 1:1226 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1415
Mailing Address - Country:US
Mailing Address - Phone:701-947-2944
Mailing Address - Fax:701-947-2273
Practice Address - Street 1:1226 1ST AVE N
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1415
Practice Address - Country:US
Practice Address - Phone:701-947-2944
Practice Address - Fax:701-947-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND310400000X, 311500000X, 311ZA0620X
ND1043A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
569350OtherWORK FORCE SAFETY
ND030029Medicaid
ND1123OtherBLUE CROSS
569350OtherWORK FORCE SAFETY