Provider Demographics
NPI:1215931977
Name:LUTHERAN HOME- ALBEMARLE, INC.
Entity type:Organization
Organization Name:LUTHERAN HOME- ALBEMARLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-982-8191
Mailing Address - Street 1:24724 S BUSINESS 52
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-8179
Mailing Address - Country:US
Mailing Address - Phone:704-982-8191
Mailing Address - Fax:704-983-1118
Practice Address - Street 1:24724 S BUSINESS 52
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8179
Practice Address - Country:US
Practice Address - Phone:704-982-8191
Practice Address - Fax:704-983-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0140314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415109Medicaid
NC00888OtherBCBS PROVIDER NUMBER
NC00888OtherBCBS PROVIDER NUMBER