Healthcare Provider Details

I. General information

NPI: 1639520034
Provider Name (Legal Business Name): LUTHER OAKS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LUTZ RD
BLOOMINGTON IL
61704-8608
US

IV. Provider business mailing address

601 LUTZ RD
BLOOMINGTON IL
61704-8608
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-5940
  • Fax: 309-664-5999
Mailing address:
  • Phone: 309-664-5940
  • Fax: 309-664-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROGER PAULSBERG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 847-368-7300