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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