Healthcare Provider Details

I. General information

NPI: 1528051901
Provider Name (Legal Business Name): LUTHERAN RETIREMENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 9TH ST N
NORTHWOOD IA
50459-1004
US

IV. Provider business mailing address

701 9TH ST N PO BOX 108
NORTHWOOD IA
50459-0108
US

V. Phone/Fax

Practice location:
  • Phone: 641-324-1712
  • Fax: 641-324-3091
Mailing address:
  • Phone: 641-324-1712
  • Fax: 641-324-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number980326
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number980326
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number980326
License Number StateIA

VIII. Authorized Official

Name: MR. SCOTT HALBACH
Title or Position: ADMINISTRATOR
Credential:
Phone: 641-324-1712