MEDICARE: LDS FAMILY SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548385560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	3000 AUBURN BLVD
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1831
Country	:	US
Telephone Number	:	916-483-2154
Fax Number	:	916-483-2850

Provider Business Practice Location Address
First Line	:	3000 AUBURN BLVD
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1831
Country	:	US
Telephone Number	:	916-483-2154
Fax Number	:	916-483-2850

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	KENNETH B. STEWART
Credential	:
Telephone Number	:	916-483-2154

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/04/2008

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