Organization
LUTHERAN HOME FOR THE AGED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE S PAYNE (CFO)
(573) 335-0158
Entity
Organization
Contact information
Practice address
2825 BLOOMFIELD RD, CAPE GIRARDEAU, MO 63703-6335
(573) 335-0158
(573) 986-6312
Mailing address
2825 BLOOMFIELD RD, CAPE GIRARDEAU, MO 63703-6398
(573) 335-0158
(573) 986-6312
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
030491
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102445400
—
MO
05
—
262445406
—
MO
05
—
268861507
—
MO
05
—
288861503
—
MO
05
—
292924008
—
MO
05
—
588585505
—
MO
Enumeration date
09/26/2005
Last updated
09/26/2025
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