Organization
LUTHERAN HOME FOR THE AGED
Active
Parent organization
LUTHERAN HOME FOR THE AGED
Other names
LUTHERAN HOME HOSPICE, Providence Home Health & Hospice
Organization subpart
Yes
Provider details
NPI number
Legal business name
LUTHERAN HOME FOR THE AGED
Authorized official
JACKIE S PAYNE (CFO)
(573) 335-0158
Entity
Organization
Contact information
Practice address
2825 BLOOMFIELD RD, CAPE GIRARDEAU, MO 63703-6335
(573) 334-1515
(573) 986-6216
Mailing address
2825 BLOOMFIELD RD, CAPE GIRARDEAU, MO 63703-6335
(573) 334-1515
(573) 986-6216
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
134-2HO
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134-2HO
STATE LICENSE
MO
Enumeration date
08/25/2006
Last updated
03/06/2023
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