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General NPI Number Information
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NPI Number | 1023766185
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 4550 N PERSHING AVE STE 120
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City | STOCKTON
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State | CA
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Zip | 95207-6737
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Country | US
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Telephone | 916-900-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 4390 47TH AVE
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City | SACRAMENTO
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State | CA
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Zip | 95824-3700
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Country | US
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Telephone | 916-900-6140
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Fax |
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Authorized Official
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Title or Position | DATA SYSTEMS MANAGER
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Name | MIXTLICOATL R GONZALEZ
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Credential |
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Telephone | 916-900-0614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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