Healthcare Provider Details

I. General information

NPI: 1295045367
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85120-4041
US

IV. Provider business mailing address

5049 E BROADWAY BLVD STE 102
TUCSON AZ
85711-3646
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-3086
  • Fax: 480-671-3109
Mailing address:
  • Phone: 520-748-2300
  • Fax: 520-748-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAL2663D
License Number StateAZ

VIII. Authorized Official

Name: CHARLES E. MONROE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 520-748-2300