Healthcare Provider Details

I. General information

NPI: 1912156530
Provider Name (Legal Business Name): GRACE LUTHERAN FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 NEW PINE DR
ALTOONA WI
54720-3300
US

IV. Provider business mailing address

PO BOX 287
EAU CLAIRE WI
54702-0287
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-8811
  • Fax: 715-838-2424
Mailing address:
  • Phone: 715-832-3003
  • Fax: 715-832-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY DUHR
Title or Position: CEO
Credential:
Phone: 715-832-3003