Healthcare Provider Details

I. General information

NPI: 1912950551
Provider Name (Legal Business Name): LUTHERAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

6801 BRECKSVILLE RD SUITE 20 RK10
INDEPENDENCE OH
44131-5032
US

V. Phone/Fax

Practice location:
  • Phone: 216-696-4300
  • Fax:
Mailing address:
  • Phone: 216-636-8051
  • Fax: 216-636-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1149
License Number StateOH

VIII. Authorized Official

Name: MR. STEVEN GLASS
Title or Position: CFO
Credential:
Phone: 216-444-9361