Healthcare Provider Details

I. General information

NPI: 1437236445
Provider Name (Legal Business Name): FAMILY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 NW F ST
GRANTS PASS OR
97526-2052
US

IV. Provider business mailing address

322 NW F ST
GRANTS PASS OR
97526-2052
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-4248
  • Fax: 541-476-0288
Mailing address:
  • Phone: 541-476-4248
  • Fax: 541-476-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number209981
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier209981
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerSTATE PROVIDER NUMBER
# 2
Identifier930875235
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerFEDERAL ID NUMBER
# 3
Identifier925369
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBLUE CROSS INSURANCE

VIII. Authorized Official

Name: DOROTHY PROVENCIO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 541-776-0497