Lutheran Orphans and Old Folks Home at Wolf Creek

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2148 Issued in OH

Legal business name

LUTHERAN ORPHANS AND OLD FOLKS HOME AT WOLF CREEK

Doing business as

Lutheran Village at Wolf Creek

Practice address

2001 Perrysburg Holland Rd
Holland, OH 43528-7005

Phone

(419) 861-2233

Fax

(419) 861-2234

NPI assigned

Jun 4, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

LUTHERAN HOMES SOCIETY, INC.As reported in NPPES

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

Authorized official

Name

Mary M Shurts

Title

Treasurer

Phone

(419) 861-4990

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lutheran Village at Wolf Creek Doing business as

Locations

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1427096056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 N MCCORD RD",
            "address_2": "STE B",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436153030",
            "telephone_number": "419-861-4990",
            "fax_number": "419-861-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 PERRYSBURG HOLLAND RD",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287005",
            "telephone_number": "419-861-2233",
            "fax_number": "419-861-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN ORPHANS AND OLD FOLKS HOME AT WOLF CREEK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN HOMES SOCIETY, INC.",
        "enumeration_date": "2006-06-04",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "SHURTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "419-861-4990"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM/BCBS",
            "identifier": "000000319925",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020360",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lutheran Village at Wolf Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marchell Luckett
• Lutheran Homes Society Inc. (Lutheran Village at Wolf Creek)
• Lutheran Homes Society Inc.
• Lutheran Homes Society Inc. (Lutheran Village at Wolf Creek)
• Lutheran Homes Society, Inc. (Genacross Lutheran Services Family and Youth)
• Sarah Elizabeth Lyczkowski, CDCA
• Kristin Lynam
• Earth Lyons
• Michael Edward Mack, DMD
• Taylor Mack, RN, CLC

• Skilled Nursing Facility in Holland, OH
• Providers in Holland, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.