Provider Demographics
NPI:1760706600
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Other - Org Name:FAMILY RESOURCE & RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF BEHAVIORAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLESSINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-748-2300
Mailing Address - Street 1:1300 E MISSOURI AVE
Mailing Address - Street 2:A-100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2362
Mailing Address - Country:US
Mailing Address - Phone:602-265-3099
Mailing Address - Fax:602-265-3123
Practice Address - Street 1:1300 E MISSOURI AVE
Practice Address - Street 2:#A-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2362
Practice Address - Country:US
Practice Address - Phone:602-265-3099
Practice Address - Fax:520-748-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3540251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131303Medicare PIN