Organization Name: | FAMILY SUPPORT SERVICES OF NORTH IDAHO |
NPI Number: | 1053536524 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JODI SMITH (EXECUTIVE DIRECTOR) |
Mailing Address: | 1115 W Ironwood Dr Suite C Coeur D Alene |
State: | ID US |
Postal Code: | 838144936 |
Phone Number: | 2087694222 |
Fax Number: | 2086677557 |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |