Provider Demographics
NPI:1528051901
Name:LUTHERAN RETIREMENT HOME, INC.
Entity type:Organization
Organization Name:LUTHERAN RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-324-1712
Mailing Address - Street 1:701 9TH ST N
Mailing Address - Street 2:PO BOX 108
Mailing Address - City:NORTHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:50459-0108
Mailing Address - Country:US
Mailing Address - Phone:641-324-1712
Mailing Address - Fax:641-324-3091
Practice Address - Street 1:701 9TH ST N
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:IA
Practice Address - Zip Code:50459-1004
Practice Address - Country:US
Practice Address - Phone:641-324-1712
Practice Address - Fax:641-324-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA980326311500000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802355Medicaid
IA03173110OtherAMERIGROUP
IA65485OtherBCBS OF IOWA
IA65485OtherBCBS OF IOWA