Provider Demographics
NPI:1376807313
Name:LUTHERAN SOCIAL SERVICES OF NORTHWESTERN OHIO
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NORTHWESTERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-LSSNWO
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-243-9178
Mailing Address - Street 1:2149 COLLINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1652
Mailing Address - Country:US
Mailing Address - Phone:419-243-9178
Mailing Address - Fax:419-243-4450
Practice Address - Street 1:2149 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1652
Practice Address - Country:US
Practice Address - Phone:419-243-9178
Practice Address - Fax:419-243-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01345OtherMEDICAID UPI
OH1881773687Medicaid
OH2472195OtherMEDICIAD PROVIDER ID
OH9276531OtherMEDICARE PTAN