Provider Demographics
NPI:1144681503
Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VIP PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERSHOM
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-534-6450
Mailing Address - Street 1:999 W TOWN AND COUNTRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4713
Mailing Address - Country:US
Mailing Address - Phone:714-475-2387
Mailing Address - Fax:
Practice Address - Street 1:515 CABRILLO PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5016
Practice Address - Country:US
Practice Address - Phone:714-534-6450
Practice Address - Fax:714-534-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health