| Doctor Name: | KENNETH LUTZ |
| NPI Number: | 1972986198 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RRT |
| License Number: | C9-0000780 |
| Business Practice Address: | 26351 Patriots Way Georgetown, DE - 199472575 |
| Business Phone Number: | 3029333000 |
| Business Fax Number: | |
| Mailing Address: | 156 Marcel Ave, FREDERICA |
| State: | DE |
| Postal Code: | 199462933 |
| Phone Number: | 3025269144 |
| Fax Number: | |
| NPI Enumeration Date: | 07/07/2015 |
| NPI Last Update Date: | 07/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | C9-0000780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |