Provider Demographics
NPI:1356527402
Name:LUTHERAN SOCIAL SERVICES OF SD
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-357-0108
Mailing Address - Street 1:705 E 41ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6048
Mailing Address - Country:US
Mailing Address - Phone:605-357-0100
Mailing Address - Fax:605-357-0140
Practice Address - Street 1:2519 WINDMILL DR
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-9588
Practice Address - Country:US
Practice Address - Phone:605-642-7188
Practice Address - Fax:605-642-3720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF SD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR100323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55517Medicaid
SD5169070Medicaid