The Lutheran Home for the Aged D/B/a the Village at Luther Square

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

314000000X Issued in PA

Legal business name

THE LUTHERAN HOME FOR THE AGED D/B/A THE VILLAGE AT LUTHER SQUARE

Practice address

149 W 22ND St
Erie, PA 16502-2804

Phone

(814) 456-5433

Fax

(814) 456-0383

NPI assigned

May 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley P Fox, MD

Title

Medical Director

Phone

(814) 456-5433

Specialties & licenses 1

Addresses

Tax ID family

Life-Northwestern Pennsylvania3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Life-Northwestern Pennsylvania

  • PACE Provider Organization
  • Erie, PA
  • NPI 1891980355
  NPD tax ID
• Lutheran Home for the Aged

  • Skilled Nursing Facility
  • Erie, PA
  • NPI 1891792354
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431043200000",
    "number": "1174901375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 W 22ND ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022804",
            "telephone_number": "814-456-5433",
            "fax_number": "814-456-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W 22ND ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022804",
            "telephone_number": "814-456-5433",
            "fax_number": "814-456-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LUTHERAN HOME FOR THE AGED D/B/A THE VILLAGE AT LUTHER SQUARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "814-456-5433",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "314000000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Pennsylvania State University
• The Regional Cancer Center
• The Regional Cancer Center
• The Regional Cancer Center
• The Sarah a. Reed Retirement Center

• Skilled Nursing Facility in Erie, PA
• Providers in Erie, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.