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General NPI Number Information
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NPI Number | 1780756890
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Entity Type | Organization
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Legal Business Name | BAY AREA LUTHERAN HOMES INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1040 PILGRIM WAY
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City | GREEN BAY
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State | WI
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Zip | 54304
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Country | US
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Telephone | 920-499-1481
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Fax | 920-499-1501
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Provider Business Mailing Address
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Address Line | 1040 PILGRIM WAY
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City | GREEN BAY
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State | WI
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Zip | 54304
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Country | US
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Telephone | 920-499-1481
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Fax | 920-499-1501
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, CAMPUS OPERATIO
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Name | POLLY GRETZINGER
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Credential |
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Telephone | 920-405-3213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2177
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License Number State | WI
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