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NPI Code Detail

MEDICARE: AMERICAN LUTHERAN CHURCH-NORTHLAND LUTHERN SERVICES FOR THE ELDERLY, I

MEDICARE: AMERICAN LUTHERAN CHURCH-NORTHLAND LUTHERN SERVICES FOR THE ELDERLY, I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2155WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376546762
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMERICAN LUTHERAN CHURCH-NORTHLAND LUTHERN SERVICES FOR THE ELDERLY, I
Provider Business Mailing Address
First Line : 831 PINE BEACH RD
Second Line :
City : MARINETTE
State : WI
Zip : 54143-4225
Country : US
Telephone Number : 715-732-0155
Fax Number : 715-732-5595
Provider Business Practice Location Address
First Line : 831 PINE BEACH RD
Second Line :
City : MARINETTE
State : WI
Zip : 54143-4225
Country : US
Telephone Number : 715-732-0155
Fax Number : 715-732-5899
Authorized Official
Title or Position : DIRECTOR OF FINANCE
Name : MR. GARY GUSTAFSON
Credential :
Telephone Number : 715-732-0155
Provider Enumeration Date : 05/31/2005
Last Update Date : 08/22/2016

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831 PINE BEACH RD
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1457429185 — NORA ABEL
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831 PINE BEACH RD
MARINETTE, WI
54143-4225
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Practice Fax:
1629127139 — CECILIA BLOCH
Practice Location Address:
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MARINETTE, WI
54143-4225
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1235289497 — ELIZABETH THORNTON
Practice Location Address:
831 PINE BEACH RD
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54143-4225
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Practice Fax:

Directions to “AMERICAN LUTHERAN CHURCH-NORTHLAND LUTHERN SERVICES FOR THE ELDERLY, I ” Practice Location

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