1952517260 NPI number — LUTHERAN SOCIAL SERVICES OF THE SOUTH, 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 1952517260 NPI number — LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF THE SOUTH, 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:
Provider Other Organization Name Type Code:
6
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:
1952517260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78714-0767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-459-1000
Provider Business Mailing Address Fax Number:
512-452-6855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 E STONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77833-5150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-830-1996
Provider Business Practice Location Address Fax Number:
979-830-0215
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FONTENOT
Authorized Official First Name:
COY
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
979-830-0073

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  101116 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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