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General NPI Number Information
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NPI Number | 1295045367
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF THE SOUTHWEST
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 1050 W SUPERSTITION BLVD
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-4041
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Country | US
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Telephone | 480-671-3086
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Fax | 480-671-3109
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Provider Business Mailing Address
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Address Line | 5049 E BROADWAY BLVD STE 102
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City | TUCSON
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State | AZ
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Zip | 85711-3646
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Country | US
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Telephone | 520-748-2300
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Fax | 520-748-2355
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CHARLES E. MONROE
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Credential |
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Telephone | 520-748-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AL2663D
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License Number State | AZ
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