1154663375 NPI number — LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.

Table of content: (NPI 1154663375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154663375 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:
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:
1154663375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST STE 2275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-246-2300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 CRANSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-420-1103
Provider Business Practice Location Address Fax Number:
608-752-9788
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TREGLOWNE
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
414-246-2300

Provider Taxonomy Codes

  • 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: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 2872 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1386719177 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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