Provider Demographics
NPI:1851524680
Name:LUTHERAN SOCIAL SERVICE OF MN
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICE OF MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-582-5260
Mailing Address - Street 1:2485 COMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1445
Mailing Address - Country:US
Mailing Address - Phone:800-582-5260
Mailing Address - Fax:
Practice Address - Street 1:19190 305TH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-7008
Practice Address - Country:US
Practice Address - Phone:651-388-7937
Practice Address - Fax:651-388-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN804381-3-WSOtherMINNESOTA DEPARTMENT OF HUMAN SERVICES