Healthcare Provider Details

I. General information

NPI: 1538108451
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF NE FL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 PHILIPS HIGHWAY
JACKSONVILLE FL
32207-7265
US

IV. Provider business mailing address

4615 PHILIPS HIGHWAY
JACKSONVILLE FL
32207-7265
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-5995
  • Fax: 904-730-8296
Mailing address:
  • Phone: 904-448-5995
  • Fax: 904-730-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD JOSEPH MOCHOWSKI
Title or Position: CONTROLLER
Credential:
Phone: 904-730-8224