Provider Demographics
NPI:1376657742
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-459-1000
Mailing Address - Street 1:8305 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5154
Mailing Address - Country:US
Mailing Address - Phone:512-459-1000
Mailing Address - Fax:512-452-6855
Practice Address - Street 1:1700 E STONE ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5150
Practice Address - Country:US
Practice Address - Phone:979-830-1996
Practice Address - Fax:979-836-4926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-19
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116813314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000718Medicaid
TX675837Medicare ID - Type Unspecified