Provider Demographics
NPI:1215308234
Name:LUTHERAN SOCIAL SERVICES OF NEVADA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NEVADA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MNATSAKANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:702-639-1730
Mailing Address - Street 1:73 SPECTRUM BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4838
Mailing Address - Country:US
Mailing Address - Phone:702-639-1730
Mailing Address - Fax:702-639-1736
Practice Address - Street 1:73 SPECTRUM BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4838
Practice Address - Country:US
Practice Address - Phone:702-639-1730
Practice Address - Fax:702-639-1736
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5948PCS-4253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV152722000354Medicaid
NV152722000356Medicaid