MEDICARE: NORTHLAND LUTHERAN HOME HEALTH SERVICES, INC.

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	256	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144223538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND LUTHERAN HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	925 PINE BEACH RD
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-4227
Country	:	US
Telephone Number	:	715-735-6222
Fax Number	:	715-735-6221

Provider Business Practice Location Address
First Line	:	925 PINE BEACH RD
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-4227
Country	:	US
Telephone Number	:	715-735-6222
Fax Number	:	715-735-6221

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	GARY GUSTAFSON
Credential	:
Telephone Number	:	715-732-0155

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/14/2015

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