1114385085 NPI number — LUTHERAN SOCIAL SERVICE OF MINNESOTA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114385085 NPI number — LUTHERAN SOCIAL SERVICE OF MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICE OF MINNESOTA
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:
Provider Other Organization Name Type Code:
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:
1114385085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2485 COMO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55108-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-582-5260
Provider Business Mailing Address Fax Number:
651-969-2350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11754 191 1/2 AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK RIVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55330-1367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-310-9451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSON
Authorized Official First Name:
BRIGID
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMPLIANCE & INTEGRATION
Authorized Official Telephone Number:
651-310-9451

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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