Provider Demographics
NPI:1114385085
Name:LUTHERAN SOCIAL SERVICE OF MINNESOTA
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICE OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE & INTEGRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGID
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-310-9451
Mailing Address - Street 1:2485 COMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1445
Mailing Address - Country:US
Mailing Address - Phone:800-582-5260
Mailing Address - Fax:651-969-2350
Practice Address - Street 1:11754 191 1/2 AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1367
Practice Address - Country:US
Practice Address - Phone:651-310-9451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities