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General NPI Number Information
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NPI Number | 1619061199
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Entity Type | Organization
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Legal Business Name | LUTHERAN HOME
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 2116 DOVER CENTER ROAD
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City | WESTLAKE
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State | OH
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Zip | 44145-3154
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Country | US
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Telephone | 440-871-0090
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Fax | 440-871-7289
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Provider Business Mailing Address
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Address Line | 2116 DOVER CENTER ROAD
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City | WESTLAKE
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State | OH
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Zip | 44145-3154
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Country | US
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Telephone | 440-871-0090
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Fax | 440-871-7289
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN MCNEA
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Credential | LNHA
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Telephone | 440-871-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0442N
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License Number State | OH
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