Provider Demographics
NPI:1114058898
Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-883-3471
Mailing Address - Street 1:2545 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6423
Mailing Address - Country:US
Mailing Address - Phone:541-883-3471
Mailing Address - Fax:541-883-3524
Practice Address - Street 1:2545 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6423
Practice Address - Country:US
Practice Address - Phone:541-883-3471
Practice Address - Fax:541-883-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164285Medicaid
OR090450Medicaid
OR026825000OtherBLUE CROSS
OR090450Medicaid
OR090450Medicare UPIN