Healthcare Provider Details

I. General information

NPI: 1992142020
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 BAILEY AVE SUITE H
NEEDLES CA
92363-3115
US

IV. Provider business mailing address

41945 BIG BEAR BLVD SUITE 222 BOX 1927
BIG BEAR LAKE CA
92315-1927
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-6699
  • Fax:
Mailing address:
  • Phone: 909-866-5070
  • Fax: 909-878-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FELIX HALLIG-RODRIGUEZ
Title or Position: COMPLIANCE DIRECTOR
Credential: BA
Phone: 760-256-7279