Provider Demographics
NPI:1700218815
Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-901-1685
Mailing Address - Street 1:4040 S 188TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2236
Practice Address - Country:US
Practice Address - Phone:360-694-5624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN COMMUNITY SERVICES NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA289251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health