Provider Demographics
NPI:1194885723
Name:LUTHERAN SOCIAL SERVICES OF SOUTH DAKOTA INC
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTH DAKOTA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:DANELLE
Authorized Official - Last Name:JONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-389-8468
Mailing Address - Street 1:705 E 41ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6053
Mailing Address - Country:US
Mailing Address - Phone:605-444-7500
Mailing Address - Fax:605-444-7540
Practice Address - Street 1:705 E 41ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6053
Practice Address - Country:US
Practice Address - Phone:605-444-7500
Practice Address - Fax:605-444-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X, 322D00000X, 3245S0500X
SD97304323P00000X
SD97302323P00000X
SD97340323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS41772Medicare PIN