Organization
LUTHERAN HOME - HICKORY WEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUS FLASKA (ADMINISTRATOR)
(828) 322-6995
Entity
Organization
Contact information
Practice address
1125 10TH STREET BLVD NW, HICKORY, NC 28601-3373
(828) 322-6995
(828) 485-0070
Mailing address
1125 10TH STREET BLVD NW, HICKORY, NC 28601-3373
(828) 322-6995
(828) 485-0070
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NC0162
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3426033
—
NC
Enumeration date
12/14/2007
Last updated
12/14/2007
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