Healthcare Provider Details

I. General information

NPI: 1568765519
Provider Name (Legal Business Name): ALLIANCE FAMILY SERVICES NORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6334 MAIN ST
BONNERS FERRY ID
83805-8519
US

IV. Provider business mailing address

608 S DIVISION AVE
SANDPOINT ID
83864-1749
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-0780
  • Fax:
Mailing address:
  • Phone: 208-265-8195
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TRACEY LANGE
Title or Position: DIRECTOR
Credential:
Phone: 208-265-8195