Provider Demographics
NPI:1093948945
Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-231-7480
Mailing Address - Street 1:605 SE 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3216
Mailing Address - Country:US
Mailing Address - Phone:503-231-7480
Mailing Address - Fax:503-233-0667
Practice Address - Street 1:605 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3216
Practice Address - Country:US
Practice Address - Phone:503-231-7480
Practice Address - Fax:503-233-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health