1144995077 NPI number — LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.

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 1144995077 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:
SAUK/COLUMBIA IOP PROGRAM
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:
1144995077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARABOO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53913-1794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-448-1011
Provider Business Mailing Address Fax Number:
608-355-4106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 BROADWAY ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARABOO
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53913-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-448-1011
Provider Business Practice Location Address Fax Number:
608-355-4106
Provider Enumeration Date:
08/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PIETROSKE
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR - FINANCIAL OPERATIONS
Authorized Official Telephone Number:
414-246-2565

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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