Healthcare Provider Details

I. General information

NPI: 1679566046
Provider Name (Legal Business Name): ST. JOHN'S LUTHERAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LUTHER PL
ALBERT LEA MN
56007-1562
US

IV. Provider business mailing address

901 LUTHER PL
ALBERT LEA MN
56007-1562
US

V. Phone/Fax

Practice location:
  • Phone: 507-373-8226
  • Fax: 507-379-9507
Mailing address:
  • Phone: 507-373-8226
  • Fax: 507-379-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number328213
License Number StateMN

VIII. Authorized Official

Name: MRS. LINETTE MARIE KLEINSCHRODT
Title or Position: REIMBURSEMENT COORDINATOR
Credential: RN
Phone: 507-373-8226