Organization
LUTHER MEMORIAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT ULRICH (ADMINISTRATOR)
(701) 786-3401
Entity
Organization
Contact information
Practice address
750 MAIN ST E, MAYVILLE, ND 58257-1606
(701) 786-3401
(701) 786-9022
Mailing address
750 MAIN ST E, MAYVILLE, ND 58257-1606
(701) 786-3401
(701) 786-9022
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
027
ND
310400000X
Assisted Living Facility
AL23
ND
314000000X
Skilled Nursing Facility
Primary
1039A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001115
ND BLUE CROSS BLUE SHIELD
ND
05
—
30024
—
ND
05
—
3050271 00
—
MN
01
—
9846LU
MN BLUE CROSS BLUE SHIELD
MN
Enumeration date
07/26/2005
Last updated
10/11/2007
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