Provider Demographics
NPI:1326113887
Name:LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.
Other - Org Name:LSS HOMME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FINANCE, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:GUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-325-3010
Mailing Address - Street 1:W18105 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-8647
Mailing Address - Country:US
Mailing Address - Phone:715-253-2116
Mailing Address - Fax:
Practice Address - Street 1:W18105 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-8647
Practice Address - Country:US
Practice Address - Phone:715-253-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43017600Medicaid