Provider Demographics
NPI:1396938882
Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Entity type:Organization
Organization Name:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PINTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:414-464-3880
Mailing Address - Street 1:4545 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4807
Mailing Address - Country:US
Mailing Address - Phone:414-464-3880
Mailing Address - Fax:414-464-5834
Practice Address - Street 1:4545 N 92ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53225-4807
Practice Address - Country:US
Practice Address - Phone:414-464-3880
Practice Address - Fax:414-464-5834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED LUTHERAN PROGRAM FOR THE AGING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIAPPLIED FOR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521585Medicare Oscar/Certification