Provider Demographics
NPI:1144864984
Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALILAH
Authorized Official - Middle Name:NARDA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-866-5070
Mailing Address - Street 1:41945 BIG BEAR BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-2030
Mailing Address - Country:US
Mailing Address - Phone:909-866-5070
Mailing Address - Fax:909-878-3228
Practice Address - Street 1:41945 BIG BEAR BLVD STE 222
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-2030
Practice Address - Country:US
Practice Address - Phone:909-866-5070
Practice Address - Fax:909-878-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty