Provider Demographics
NPI:1548003809
Name:LUTHER HOME LLC
Entity type:Organization
Organization Name:LUTHER HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-387-2666
Mailing Address - Street 1:43304 KIPTON NICKLE PLATE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9725
Mailing Address - Country:US
Mailing Address - Phone:440-387-2666
Mailing Address - Fax:
Practice Address - Street 1:116 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1037
Practice Address - Country:US
Practice Address - Phone:440-387-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities