Provider Demographics
NPI:1942510201
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Entity Type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-748-2300
Mailing Address - Street 1:5049 E BROADWAY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3646
Mailing Address - Country:US
Mailing Address - Phone:520-748-2300
Mailing Address - Fax:520-748-2355
Practice Address - Street 1:5049 E BROADWAY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3646
Practice Address - Country:US
Practice Address - Phone:520-748-2300
Practice Address - Fax:520-748-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870908Medicaid