Provider Demographics
NPI:1740341833
Name:SPIRITRUST LUTHERAN
Entity type:Organization
Organization Name:SPIRITRUST LUTHERAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUNDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-854-3971
Mailing Address - Street 1:1050 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1983
Mailing Address - Country:US
Mailing Address - Phone:717-854-3971
Mailing Address - Fax:717-854-6808
Practice Address - Street 1:750 KELLY DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2433
Practice Address - Country:US
Practice Address - Phone:717-848-2585
Practice Address - Fax:717-852-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA350640310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility