Provider Demographics
NPI:1225459027
Name:LUTHERAN SOCIAL SERVICES OF ND
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-7341
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-0389
Mailing Address - Country:US
Mailing Address - Phone:701-235-7341
Mailing Address - Fax:701-271-3270
Practice Address - Street 1:3911 20TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58107
Practice Address - Country:US
Practice Address - Phone:701-235-7341
Practice Address - Fax:701-271-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND050955Medicaid
ND54635Medicaid
ND55350Medicaid