Provider Demographics
NPI:1538108451
Name:LUTHERAN SOCIAL SERVICES OF NE FL INC
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NE FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-730-8224
Mailing Address - Street 1:4615 PHILIPS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7265
Mailing Address - Country:US
Mailing Address - Phone:904-448-5995
Mailing Address - Fax:904-730-8296
Practice Address - Street 1:4615 PHILIPS HIGHWAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7265
Practice Address - Country:US
Practice Address - Phone:904-448-5995
Practice Address - Fax:904-730-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029597302Medicaid