Healthcare Provider Details

I. General information

NPI: 1457355091
Provider Name (Legal Business Name): LUTHERAN HOME AT KANE PENNSYLVANIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH POINT DRIVE
KANE PA
16735-9704
US

IV. Provider business mailing address

100 HIGH POINT DRIVE
KANE PA
16735-9704
US

V. Phone/Fax

Practice location:
  • Phone: 814-837-6706
  • Fax: 814-837-1051
Mailing address:
  • Phone: 814-837-6706
  • Fax: 814-837-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number902802
License Number StatePA

VIII. Authorized Official

Name: MRS. MEGAN M BOLDEN
Title or Position: ADMINISTRATOR
Credential: N.H.A.
Phone: 814-837-6706