Provider Demographics
NPI:1023766185
Name:LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA SYSTEMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIXTLICOATL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-900-0614
Mailing Address - Street 1:4390 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3700
Mailing Address - Country:US
Mailing Address - Phone:916-900-6140
Mailing Address - Fax:
Practice Address - Street 1:4550 N PERSHING AVE STE 120
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6737
Practice Address - Country:US
Practice Address - Phone:916-900-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-16
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health