Provider Demographics
NPI:1316317423
Name:LUTHERAN HAVEN EXTENDED CONGREGATE CARE, LLC
Entity type:Organization
Organization Name:LUTHERAN HAVEN EXTENDED CONGREGATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-365-5676
Mailing Address - Street 1:2041 W SR 426
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8548
Mailing Address - Country:US
Mailing Address - Phone:407-365-5676
Mailing Address - Fax:407-366-0128
Practice Address - Street 1:2035 W SR 426
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8524
Practice Address - Country:US
Practice Address - Phone:407-365-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN HAVEN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)