MEDICARE: LUTHERAN HOMES OF MICHIGAN, 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	310400000X	Assisted Living Facility	AH 730236833	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O 9648	OTHER	MI	BCBS PROVIDER #

General Provider Information

NPI Number	:	1609870286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN HOMES OF MICHIGAN, INC.

Provider Business Mailing Address
First Line	:	9710 JUNCTION RD
Second Line	:	P.O. BOX 329
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-0329
Country	:	US
Telephone Number	:	989-652-3470
Fax Number	:	989-652-3480

Provider Business Practice Location Address
First Line	:	725 W GENESEE ST
Second Line	:	HOME FOR THE AGED
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-1316
Country	:	US
Telephone Number	:	989-652-9951
Fax Number	:	989-652-0339

Authorized Official
Title or Position	:	CFO
Name	:	MR. TIMOTHY ROBERT KALBFLEISCH
Credential	:
Telephone Number	:	248-635-3316

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/24/2024

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