Basic Information
| Provider Information | |||||||||
| NPI: | 1528494796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1927 | ||||||||
| Address2: | |||||||||
| City: | BIG BEAR LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098665070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 82820 TRONA RD STE C | ||||||||
| Address2: | |||||||||
| City: | TRONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935621929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603725159 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2013 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | HALLIG-RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | FELIX | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7602567279 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BA | ||||||||
| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.