MEDICARE: LUTHERAN HOME CARE AGENCY, 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	251G00000X	Community Based Hospice Care Agency	733513	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71010000008787	OTHER	MI	BCBS INS.-PROV #
2	0989890	OTHER	MI	HEALTH PLUS INS. - PROV #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467456434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN HOME CARE AGENCY, INC.

Provider Business Mailing Address
First Line	:	100 MAYER ROAD
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-9502
Country	:	US
Telephone Number	:	989-652-4663
Fax Number	:	989-652-3279

Provider Business Practice Location Address
First Line	:	100 MAYER ROAD
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-9502
Country	:	US
Telephone Number	:	989-652-4663
Fax Number	:	989-652-3279

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LYNN MAURER
Credential	:	RN
Telephone Number	:	989-652-4663

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/28/2012

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