Provider Demographics
NPI:1952372856
Name:ST LUKE'S LUTHERAN CARE CENTER
Entity type:Organization
Organization Name:ST LUKE'S LUTHERAN CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-526-6301
Mailing Address - Street 1:1219 S RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2227
Mailing Address - Country:US
Mailing Address - Phone:507-526-2184
Mailing Address - Fax:507-526-7427
Practice Address - Street 1:1219 S RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2227
Practice Address - Country:US
Practice Address - Phone:507-526-2184
Practice Address - Fax:507-526-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN428540900Medicaid
MN245372Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER