Healthcare Provider Details

I. General information

NPI: 1578896205
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 S MAIN ST
LIMA OH
45804-1519
US

IV. Provider business mailing address

799 S MAIN ST
LIMA OH
45804-1519
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-2227
  • Fax:
Mailing address:
  • Phone: 419-229-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0007584
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TAMMIE COLON
Title or Position: VICE PRESIDENT
Credential: MSSA, LSW
Phone: 419-229-2222