MEDICARE: LUTHERAN CHHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124462254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN CHHA

Provider Business Mailing Address
First Line	:	5434 2ND AVE
Second Line	:	LUTHERAN AUGUSTANA CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5434 2ND AVE
Second Line	:	LUTHERAN AUGUSTANA CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2606
Country	:	US
Telephone Number	:	718-630-6000
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESDIENT - FINANCE
Name	:	MICHAEL PAGANO
Credential	:
Telephone Number	:	718-630-8298

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	11/13/2014

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