Provider Demographics
NPI:1427210335
Name:LUTHERAN SOCIAL SERVICES OF SOUTH DAKOTA
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTH DAKOTA
Other - Org Name:SUMMIT OAKS CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, PROGRAM SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-357-0102
Mailing Address - Street 1:705 E 41ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6048
Mailing Address - Country:US
Mailing Address - Phone:605-357-0112
Mailing Address - Fax:605-357-0140
Practice Address - Street 1:621 E PRESENTATION ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0820
Practice Address - Country:US
Practice Address - Phone:605-221-2346
Practice Address - Fax:605-221-2404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF SOUTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR12671322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5167020Medicaid