MEDICARE: LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1245462969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	2450 ALHAMBRA BLVD STE 101
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1120
Country	:	US
Telephone Number	:	916-453-2900
Fax Number	:	916-454-2930

Provider Business Practice Location Address
First Line	:	2450 ALHAMBRA BLVD STE 101
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1120
Country	:	US
Telephone Number	:	916-453-2900
Fax Number	:	916-454-2930

Authorized Official
Title or Position	:	DATA SYSTEMS MANAGER
Name	:	MIXTLICOATL R GONZALEZ
Credential	:
Telephone Number	:	916-900-0614

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	10/11/2022

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