NPIMap

Organization Active NPI

Lutheran Home for the Aged

  • Community Based Hospice Care Agency
  • Cape Girardeau, MO
National Provider Identifier
1720195431
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
134-2HO Issued in MO
Legal business name
LUTHERAN HOME FOR THE AGED
Practice address
2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335
Phone
(573) 334-1515
Fax
(573) 986-6216
NPI assigned
Aug 25, 2006
Organization subpart
Yes
Parent organization
LUTHERAN HOME FOR THE AGEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Authorized official

Name
Jackie S Payne
Title
Cfo
Phone
(573) 335-0158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 134-2HO MO Primary

Addresses

Primary practice location

2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335

Mailing address

2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335
Phone (573) 334-1515

Other identifiers 1

IdentifierTypeStateIssuer
134-2HOOtherMOSTATE LICENSE

Other names 2

  • Providence Home Health & Hospice Doing business as
  • LUTHERAN HOME HOSPICE Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091020000434 MO Part A Provider - Hospice 4385630318 1 other NPI on this enrollment
Practice locations: Cape Girardeau, MO

Hospice certification: CCN 261599

Legal name
LUTHERAN HOME FOR THE AGED
Doing business as
PROVIDENCE HOME HEALTH & HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 14, 2004
Last certification
Jan 23, 2020
Ownership / control type
Non-Profit - Church
Organization structure
CorporationNon-profit
Incorporated
May 29, 1967 in MO
Enrollment address
2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence Home Health & HospiceCCN 261599
Ownership
Non-Profit
Certified
Apr 14, 2004
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Home Hospice8 organizations share this tax ID, including this one
Part of
Lutheran Home Hospice

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jackie Payne Individual Corporate OfficerCfo Apr 26, 2018
W-2 Managing EmployeeCfo Apr 26, 2018
Operational/Managerial Control Apr 26, 2018
Harold Hale Individual Corporate OfficerTreasurer Apr 1, 2015
Corporate DirectorBoard Member Dec 17, 2012
Rex Meyr Individual Corporate OfficerPresident Apr 1, 2000
Corporate DirectorBoad Member Apr 1, 1997
Teresa Brown Individual Corporate OfficerCoo May 11, 2015
W-2 Managing EmployeeCoo May 11, 2015
Operational/Managerial ControlCoo May 11, 2015
Cindy Lichtenegger Individual Corporate Director Apr 1, 2021
Mark Kasten Individual Corporate OfficerSecretary Apr 1, 2015
Corporate DirectorBoard Member Apr 1, 2004
John Freeze Individual Corporate DirectorBoard Member Mar 18, 2012
Steve Schnieder Individual Corporate Director Dec 22, 2014
Brent Presser Individual Corporate Director Jul 1, 2021

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1720195431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 BLOOMFIELD RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036335",
            "telephone_number": "573-334-1515",
            "fax_number": "573-986-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 BLOOMFIELD RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036335",
            "telephone_number": "573-334-1515",
            "fax_number": "573-986-6216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOME FOR THE AGED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN HOME FOR THE AGED",
        "enumeration_date": "2006-08-25",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-335-0158"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "134-2HO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "134-2HO",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Home Health & Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LUTHERAN HOME HOSPICE",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LUTHERAN HOME HOSPICE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.