Healthcare Provider Details

I. General information

NPI: 1962524272
Provider Name (Legal Business Name): WISCONSIN LUTHERAN HOME MINISTRIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 N MAIN ST
RIVER FALLS WI
54022-1537
US

IV. Provider business mailing address

640 N MAIN ST
RIVER FALLS WI
54022-1537
US

V. Phone/Fax

Practice location:
  • Phone: 715-425-5353
  • Fax: 715-425-9911
Mailing address:
  • Phone: 715-425-5353
  • Fax: 715-425-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3084
License Number StateWI

VIII. Authorized Official

Name: MERILEE JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-425-5353