Healthcare Provider Details

I. General information

NPI: 1669896346
Provider Name (Legal Business Name): FAMILY CONNECTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WILLOW AVE SUITE 305
COUNCIL BLUFFS IA
51503-0827
US

IV. Provider business mailing address

500 WILLOW AVE SUITE 305
COUNCIL BLUFFS IA
51503-0827
US

V. Phone/Fax

Practice location:
  • Phone: 712-256-4420
  • Fax: 712-256-4423
Mailing address:
  • Phone: 712-256-4420
  • Fax: 712-256-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number001733
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number001733
License Number StateIA

VIII. Authorized Official

Name: MR. TRENT L RICE
Title or Position: DIRECTOR
Credential:
Phone: 712-256-4420