Provider Demographics
NPI:1528193018
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Other - Org Name:NELSON CHILDREN'S TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-484-8232
Mailing Address - Street 1:8305 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5154
Mailing Address - Country:US
Mailing Address - Phone:512-459-1000
Mailing Address - Fax:512-452-6855
Practice Address - Street 1:4601 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3419
Practice Address - Country:US
Practice Address - Phone:940-484-8232
Practice Address - Fax:940-484-1385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141603401Medicaid