# LUTHERAN HOME FOR THE AGED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Village at Luther Square
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891792354
- **Authorized official:** MR. MARK J. GUSEK (C EO)
- **Authorized official phone:** (814) 452-3271

## Contact information

- **Practice address:** 149 W 22ND ST, ERIE, PA 16502-2804
- **Practice address phone:** (814) 452-3271
- **Practice address fax:** (814) 456-0383
- **Mailing address:** 149 W 22ND ST, ERIE, PA 16502-2804
- **Mailing address phone:** (814) 452-3271
- **Mailing address fax:** (814) 456-0383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 382602 | PA | Yes |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 01/03/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0648 | BLUE CROSS PROVIDER NO. | PA |
| 05 | — | 1007767250002 | — | PA |