Healthcare Provider Details

I. General information

NPI: 1962627430
Provider Name (Legal Business Name): FAMILY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W IRONWOOD DR SUITE C
COEUR D ALENE ID
83814-4936
US

IV. Provider business mailing address

1115 W IRONWOOD DR SUITE C
COEUR D ALENE ID
83814-4936
US

V. Phone/Fax

Practice location:
  • Phone: 208-769-4222
  • Fax: 208-667-7557
Mailing address:
  • Phone: 208-769-4222
  • Fax: 208-667-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateID

VIII. Authorized Official

Name: MRS. JODI SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED
Phone: 208-769-4222