Provider Demographics
NPI:1417019993
Name:LUTHERAN SOCIAL SERVICE
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JERALEE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SCHOONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-969-2348
Mailing Address - Street 1:716 E ST NE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2857
Mailing Address - Country:US
Mailing Address - Phone:218-824-3744
Mailing Address - Fax:218-829-9217
Practice Address - Street 1:302 1ST ST.
Practice Address - Street 2:CROSS HOME
Practice Address - City:ADAMS
Practice Address - State:MN
Practice Address - Zip Code:55909
Practice Address - Country:US
Practice Address - Phone:507-324-3725
Practice Address - Fax:507-324-3728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICE OF MN.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800037-3-RS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities