Healthcare Provider Details

I. General information

NPI: 1730104415
Provider Name (Legal Business Name): LUTHERAN CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST AVE NE
LITTLE FALLS MN
56345-3309
US

IV. Provider business mailing address

1200 1ST AVE NE
LITTLE FALLS MN
56345-3309
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-9211
  • Fax: 320-632-2097
Mailing address:
  • Phone: 320-632-9211
  • Fax: 320-632-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number331606
License Number StateMN

VIII. Authorized Official

Name: MR. HERMAN JOHANNES
Title or Position: PRESIDENT
Credential:
Phone: 320-632-9211