Provider Demographics
NPI:1841672284
Name:THE LUTHERAN UNIVERSITY ASSOCIATION INC.
Entity type:Organization
Organization Name:THE LUTHERAN UNIVERSITY ASSOCIATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHENAUR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:219-464-5352
Mailing Address - Street 1:1700 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4520
Mailing Address - Country:US
Mailing Address - Phone:219-464-5000
Mailing Address - Fax:
Practice Address - Street 1:55 UNIVERSITY DR
Practice Address - Street 2:SUITE #102
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2195
Practice Address - Country:US
Practice Address - Phone:219-464-5060
Practice Address - Fax:219-464-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health