Basic Information
| Provider Information | |||||||||
| NPI: | 1902969116 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUTHERAN COMMUNITY SERVICE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 203 NE COURT ST | ||||||||
| Address2: | |||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977541935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414477441 | ||||||||
| FaxNumber: | 5414472066 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 NE COURT ST | ||||||||
| Address2: | |||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977541935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414477441 | ||||||||
| FaxNumber: | 5414472066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | ROBBINS | ||||||||
| AuthorizedOfficialTitleorPosition: | CARE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5414806626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | B.S.W. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.