Provider Demographics
NPI:1356558878
Name:LUTHERAN SOCIAL SERVICES OF ND
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF ND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-7341
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-0389
Mailing Address - Country:US
Mailing Address - Phone:701-235-7341
Mailing Address - Fax:
Practice Address - Street 1:3911 20TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-235-7341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND050955Medicaid
ND55350Medicaid
ND57446Medicaid
ND54635Medicaid
0005817398OtherAETNA
ND10355OtherBLUE CROSS BLUE SHIELD ND
50-50094OtherMEDICA
0005817398OtherAETNA