Provider Demographics
NPI:1417951146
Name:LUTHERAN HOMES OF MICHIGAN, INC
Entity type:Organization
Organization Name:LUTHERAN HOMES OF MICHIGAN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KALBFLEISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-635-3316
Mailing Address - Street 1:9710 JUNCTION RD.
Mailing Address - Street 2:P.O. BOX 329
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-0329
Mailing Address - Country:US
Mailing Address - Phone:989-652-3470
Mailing Address - Fax:989-652-3480
Practice Address - Street 1:1236 S MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3934
Practice Address - Country:US
Practice Address - Phone:734-241-9533
Practice Address - Fax:734-241-9108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN HOMES OF MICHIGAN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI584020314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2081821Medicaid
MIO 9665OtherBCBS INS. PROVIDER #
MI2081821Medicaid