Provider Demographics
NPI:1588446256
Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CALAIM PROGRAMS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSPH, CMPE
Authorized Official - Phone:714-244-4261
Mailing Address - Street 1:999 W TOWN AND COUNTRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4713
Mailing Address - Country:US
Mailing Address - Phone:714-685-1800
Mailing Address - Fax:714-685-1800
Practice Address - Street 1:1354 N G ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-5045
Practice Address - Country:US
Practice Address - Phone:909-381-6921
Practice Address - Fax:909-381-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health