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General NPI Number Information
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NPI Number | 1245415363
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Entity Type | Organization
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Legal Business Name | LUTHERAN HOME AT TRINITY OAKS
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 820 KLUMAC RD
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City | SALISBURY
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State | NC
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Zip | 28144-5722
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Country | US
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Telephone | 704-637-3784
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Fax | 704-636-9464
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Provider Business Mailing Address
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Address Line | 820 KLUMAC RD
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City | SALISBURY
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State | NC
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Zip | 28144-5722
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Country | US
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Telephone | 704-637-3784
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Fax | 704-636-9464
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BILL JOHNSON
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Credential |
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Telephone | 704-637-3784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | NH0197
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License Number State | NC
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