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General NPI Number Information
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NPI Number | 1962524272
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Entity Type | Organization
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Legal Business Name | WISCONSIN LUTHERAN HOME MINISTRIES INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 640 N MAIN ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-1537
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Country | US
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Telephone | 715-425-5353
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Fax | 715-425-9911
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Provider Business Mailing Address
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Address Line | 640 N MAIN ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-1537
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Country | US
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Telephone | 715-425-5353
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Fax | 715-425-9911
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MERILEE JOHNSON
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Credential |
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Telephone | 715-425-5353
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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 | 3084
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License Number State | WI
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