Healthcare Provider Details

I. General information

NPI: 1285139220
Provider Name (Legal Business Name): FAMILY CONNECT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 PARKMOOR VILLAGE DR
COLORADO SPRINGS CO
80917-6252
US

IV. Provider business mailing address

3709 PARKMOOR VILLAGE DR
COLORADO SPRINGS CO
80917-6252
US

V. Phone/Fax

Practice location:
  • Phone: 719-600-8049
  • Fax:
Mailing address:
  • Phone: 719-600-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA OLSON
Title or Position: CEO
Credential: MS, MED
Phone: 719-600-8049