MEDICARE: ALLIANCE FAMILY SERVICES NORTH, INC

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	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1255515441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FAMILY SERVICES NORTH, INC

Provider Business Mailing Address
First Line	:	608 S DIVISION AVE
Second Line	:
City	:	SANDPOINT
State	:	ID
Zip	:	83864-1749
Country	:	US
Telephone Number	:	208-265-5049
Fax Number	:	208-263-7515

Provider Business Practice Location Address
First Line	:	1101 W MOANA LN
Second Line	:	SUITE 2
City	:	RENO
State	:	NV
Zip	:	89509-4775
Country	:	US
Telephone Number	:	775-337-2394
Fax Number	:	775-337-9570

Authorized Official
Title or Position	:	MEDICAID BILLING MANAGER
Name	:	FRYTHE SPALDING
Credential	:
Telephone Number	:	208-265-5049

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	07/21/2022

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