Provider Demographics
NPI:1518398890
Name:THE LUTHERAN HOME: CEDAR HAVEN
Entity type:Organization
Organization Name:THE LUTHERAN HOME: CEDAR HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-873-4750
Mailing Address - Street 1:640 REED ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4306
Mailing Address - Country:US
Mailing Address - Phone:507-625-1512
Mailing Address - Fax:507-388-6428
Practice Address - Street 1:640 REED ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4306
Practice Address - Country:US
Practice Address - Phone:507-625-1512
Practice Address - Fax:507-388-6428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LUTHERAN HOME ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN358703310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN358703Medicaid