# THE LUTHERAN HOME FOR THE AGED D/B/A THE VILLAGE AT LUTHER SQUARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174901375
- **Authorized official:** BRADLEY P FOX MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (814) 456-5433

## Contact information

- **Practice address:** 149 W 22ND ST, ERIE, PA 16502-2804
- **Practice address phone:** (814) 456-5433
- **Practice address fax:** (814) 456-0383
- **Mailing address:** 149 W 22ND ST, ERIE, PA 16502-2804
- **Mailing address phone:** (814) 456-5433
- **Mailing address fax:** (814) 456-0383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 314000000X | PA | Yes |

## Other

- **Enumeration date:** 05/08/2015
- **Last updated:** 05/08/2015