Healthcare Provider Details

I. General information

NPI: 1003811571
Provider Name (Legal Business Name): GOOD SHEPHERD LUTHERAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOME ST
RUSHFORD MN
55971-8836
US

IV. Provider business mailing address

PO BOX 747
RUSHFORD MN
55971-0747
US

V. Phone/Fax

Practice location:
  • Phone: 507-864-7714
  • Fax: 507-864-2842
Mailing address:
  • Phone: 507-864-7714
  • Fax: 507-864-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0033469
License Number StateMN

VIII. Authorized Official

Name: RHONDA SPECE
Title or Position: ACCOUNTING SERVICE DIRECTOR
Credential:
Phone: 507-864-7714