Healthcare Provider Details

I. General information

NPI: 1376657742
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E STONE ST
BRENHAM TX
77833-5150
US

IV. Provider business mailing address

8305 CROSS PARK DR
AUSTIN TX
78754-5154
US

V. Phone/Fax

Practice location:
  • Phone: 979-830-1996
  • Fax: 979-836-4926
Mailing address:
  • Phone: 512-459-1000
  • Fax: 512-452-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116813
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL LOO
Title or Position: PRESIDENT & COO
Credential:
Phone: 512-459-1000