Provider Demographics
NPI:1881698165
Name:LUTHER MANOR ASSOCIATION
Entity type:Organization
Organization Name:LUTHER MANOR ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-221-5533
Mailing Address - Street 1:3170 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6571
Mailing Address - Country:US
Mailing Address - Phone:573-221-5533
Mailing Address - Fax:573-221-3634
Practice Address - Street 1:3170 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6571
Practice Address - Country:US
Practice Address - Phone:573-221-5533
Practice Address - Fax:573-221-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028345314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101473007Medicaid
MO265690Medicare Oscar/Certification