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General NPI Number Information
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NPI Number | 1144223538
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Entity Type | Organization
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Legal Business Name | NORTHLAND LUTHERAN HOME HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 925 PINE BEACH RD
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City | MARINETTE
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State | WI
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Zip | 54143-4227
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Country | US
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Telephone | 715-735-6222
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Fax | 715-735-6221
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Provider Business Mailing Address
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Address Line | 925 PINE BEACH RD
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City | MARINETTE
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State | WI
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Zip | 54143-4227
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Country | US
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Telephone | 715-735-6222
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Fax | 715-735-6221
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | GARY GUSTAFSON
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Credential |
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Telephone | 715-732-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 256
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License Number State | WI
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