Provider Demographics
NPI:1033176557
Name:LUTHERAN SENIOR SERVICES EAST
Entity type:Organization
Organization Name:LUTHERAN SENIOR SERVICES EAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-968-9313
Mailing Address - Street 1:1 S HOME AVE
Mailing Address - Street 2:
Mailing Address - City:TOPTON
Mailing Address - State:PA
Mailing Address - Zip Code:19562-1317
Mailing Address - Country:US
Mailing Address - Phone:314-968-9313
Mailing Address - Fax:
Practice Address - Street 1:189 EAST TRESSLER BOULEVARD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8808
Practice Address - Country:US
Practice Address - Phone:570-524-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SENIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-27
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
PA023602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777400014Medicaid
PA395261Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER