Provider Demographics
NPI:1861636136
Name:LUTHERAN SOCIAL SERVICES OF INDIANA INC.
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF INDIANA INC.
Other - Org Name:LUTHERAN SOCIAL SERVICES OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-242-6633
Mailing Address - Street 1:333 E LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3139
Mailing Address - Country:US
Mailing Address - Phone:260-426-3347
Mailing Address - Fax:260-426-2248
Practice Address - Street 1:333 E LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3139
Practice Address - Country:US
Practice Address - Phone:260-426-3347
Practice Address - Fax:260-426-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200072230Medicaid