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NPI Code Detail

MEDICARE: LUTHERAN HOME- ALBEMARLE, INC

MEDICARE: LUTHERAN HOME- ALBEMARLE, 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
1313M00000XNursing Facility/Intermediate Care FacilityNH0140NC

General Provider Information

NPI Number : 1578746699
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUTHERAN HOME- ALBEMARLE, INC
Provider Business Mailing Address
First Line : PO BOX 308
Second Line :
City : ALBEMARLE
State : NC
Zip : 28002-0308
Country : US
Telephone Number : 704-982-8191
Fax Number : 704-983-1118
Provider Business Practice Location Address
First Line : 24724 US HIGHWAY 52 S
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-8179
Country : US
Telephone Number : 704-982-8191
Fax Number : 704-983-1118
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. PRISCILLA A VINT
Credential :
Telephone Number : 704-982-8191
Provider Enumeration Date : 12/12/2007
Last Update Date : 08/07/2008

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