=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326035577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUTHERCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2005
-----------------------------------------------------
Last Update Date | 01/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 DUKE STREET
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-274-1495
-----------------------------------------------------
Fax | 717-274-1592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 EAST MAIN ST
-----------------------------------------------------
City | LITITZ
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17543-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-626-1171
-----------------------------------------------------
Fax | 717-626-1610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MR. CARL R MCALOOSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-626-1171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 193602
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------