Healthcare Provider Details

I. General information

NPI: 1164579173
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 MONTWOOD DR
EL PASO TX
79925-6032
US

IV. Provider business mailing address

PO BOX 140767
AUSTIN TX
78714-0767
US

V. Phone/Fax

Practice location:
  • Phone: 915-598-5403
  • Fax: 915-592-7399
Mailing address:
  • Phone: 512-459-1000
  • Fax: 512-452-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number003245
License Number StateTX

VIII. Authorized Official

Name: MR. JOHN BERKELY
Title or Position: VICE PRESIDENT SENIOR SERVICES
Credential:
Phone: 512-459-1000