=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053317735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUTHERAN HOME CARE AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 02/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MAYER ROAD
-----------------------------------------------------
City | FRANKENMUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48734-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-652-4663
-----------------------------------------------------
Fax | 989-652-3279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MAYER ROAD
-----------------------------------------------------
City | FRANKENMUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48734-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-652-4663
-----------------------------------------------------
Fax | 989-652-3279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | LYNN MAURER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 989-652-4663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------