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General NPI Number Information
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NPI Number | 1700218815
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Entity Type | Organization
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Legal Business Name | LUTHERAN COMMUNITY SERVICES NORTHWEST
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 3600 MAIN ST SUITE 200
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City | VANCOUVER
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State | WA
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Zip | 98663-2236
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Country | US
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Telephone | 360-694-5624
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Fax |
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Provider Business Mailing Address
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Address Line | 4040 S 188TH ST
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City | SEATAC
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State | WA
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Zip | 98188-5070
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ROBERTA NESTAAS
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Credential |
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Telephone | 206-901-1685
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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 | 289
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License Number State | WA
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