Healthcare Provider Details

I. General information

NPI: 1760460489
Provider Name (Legal Business Name): AMERICAN LUTHERAN CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 COLLEGE
ELK HORN IA
51531-0703
US

IV. Provider business mailing address

2027 COLLEGE ST
ELK HORN IA
51531-8007
US

V. Phone/Fax

Practice location:
  • Phone: 712-764-4201
  • Fax: 712-764-4206
Mailing address:
  • Phone: 712-764-4201
  • Fax: 712-764-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number830061
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RAYE NAE NYLANDER
Title or Position: VICE PRESIDENT CFO
Credential:
Phone: 605-362-3100