Organization
LUTHERAN HOME FOR THE AGED
Active
Other names
The Village at Luther Square
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK J. GUSEK (C EO)
(814) 452-3271
Entity
Organization
Contact information
Practice address
149 W 22ND ST, ERIE, PA 16502-2804
(814) 452-3271
(814) 456-0383
Mailing address
149 W 22ND ST, ERIE, PA 16502-2804
(814) 452-3271
(814) 456-0383
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
382602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0648
BLUE CROSS PROVIDER NO.
PA
05
—
1007767250002
—
PA
Enumeration date
06/30/2005
Last updated
01/03/2011
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