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Organization
IMMANUEL LUTHERAN CORPORATION
Active
Organization
IMMANUEL LUTHERAN CORPORATION
Active
Other names
Immanuel Lutheran Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH GENDREAU LNHA CEO,CALA, FELLO (ADMINSTRATOR.CEO)
(406) 752-9622
Entity
Organization
Contact information
Practice address
185 CRESTLINE AVE, KALISPELL, MT 59901-3573
(406) 752-9622
(406) 752-9615
Mailing address
185 CRESTLINE AVE, KALISPELL, MT 59901-3573
(406) 752-9622
(406) 752-9615
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10077
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0313300
—
MT
05
—
0347815
—
MT
05
—
0348023
—
MT
05
—
0534430
—
MT
01
—
40632
BCBS
MT
Enumeration date
07/18/2005
Last updated
12/20/2010
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