Healthcare Provider Details

I. General information

NPI: 1780847913
Provider Name (Legal Business Name): ALLIANCE FAMILY SERVICES NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W IRONWOOD DR STE 101
COEUR D ALENE ID
83814-2660
US

IV. Provider business mailing address

608 S DIVISION AVE
SANDPOINT ID
83864-1749
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-5049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRACEY LANGE
Title or Position: DIRECTOR
Credential:
Phone: 208-265-5049