Provider Demographics
NPI:1194197459
Name:LUTHERAN SUNSET HOME CORPORATION
Entity type:Organization
Organization Name:LUTHERAN SUNSET HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-352-1901
Mailing Address - Street 1:333 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1233
Mailing Address - Country:US
Mailing Address - Phone:701-352-1901
Mailing Address - Fax:701-352-1926
Practice Address - Street 1:333 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1233
Practice Address - Country:US
Practice Address - Phone:701-352-1901
Practice Address - Fax:701-352-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8108311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1458265Medicaid
ND1636OtherBC/BS
ND1636OtherBC/BS