1386969723 NPI number — LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.

Table of content: (NPI 1386969723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386969723 NPI number — LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LUTHERAN SOCIAL SERVICES OF WI AND UPPER MI OUTPATIENT COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386969723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 WINNEBAGO ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53704-5315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-234-2074
Provider Business Mailing Address Fax Number:
608-270-6651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 W CENTRAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-2335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-855-5300
Provider Business Practice Location Address Fax Number:
715-839-7024
Provider Enumeration Date:
03/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ARZBECKER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
800-488-5181

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  13165 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 2872 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42112200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com