Healthcare Provider Details

I. General information

NPI: 1346341427
Provider Name (Legal Business Name): FAMILY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/29/2023
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST STE 4B
MEDFORD OR
97501-2734
US

IV. Provider business mailing address

1836 FREMONT ST
ASHLAND OR
97520-2537
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-1720
  • Fax: 541-414-1724
Mailing address:
  • Phone: 541-414-1720
  • Fax: 541-414-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY J PROVENCIO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-414-1720