MEDICARE: LUTHERAN HAVEN NURSING HOME AND ASSISTED LIVING FACILITY, LLC

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	314000000X	Skilled Nursing Facility	SNF1300096	FL

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

General Provider Information

NPI Number	:	1326044322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN HAVEN NURSING HOME AND ASSISTED LIVING FACILITY, LLC

Provider Business Mailing Address
First Line	:	2041 WEST STATE RD 426
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765
Country	:	US
Telephone Number	:	407-365-5676
Fax Number	:	407-366-0128

Provider Business Practice Location Address
First Line	:	1525 HAVEN DRIVE
Second Line	:	ATTN: NURSING HOME ADMINISTRATOR
City	:	OVIEDO
State	:	FL
Zip	:	32765
Country	:	US
Telephone Number	:	407-365-3456
Fax Number	:	407-706-1256

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LINDA ANN KIRK
Credential	:
Telephone Number	:	407-365-5676

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/25/2014

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