Provider Demographics
NPI:1720033103
Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Other - Org Name:LUTHERAN SOCIAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-866-5070
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1927
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:909-878-3228
Practice Address - Street 1:41945 BIG BEAR BLVD
Practice Address - Street 2:SUITES 221, 222,223
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1927
Practice Address - Country:US
Practice Address - Phone:909-866-5070
Practice Address - Fax:909-878-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR09882Medicare UPIN
CACB316AMedicare PIN