Healthcare Provider Details

I. General information

NPI: 1114925120
Provider Name (Legal Business Name): AMERICAN LUTHERAN HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 UNIVERSITY DR S
FARGO ND
58103-1775
US

IV. Provider business mailing address

201 UNIVERSITY DR S
FARGO ND
58103-1775
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3000
  • Fax: 701-239-3237
Mailing address:
  • Phone: 701-239-3000
  • Fax: 701-239-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1020
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1020A
License Number StateND

VIII. Authorized Official

Name: MR. SHAWN STUHAUG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 701-239-3000