Healthcare Provider Details

I. General information

NPI: 1205965415
Provider Name (Legal Business Name): FAMILY & CHILDREN'S CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 MAIN ST
LA CROSSE WI
54601-4200
US

IV. Provider business mailing address

1707 MAIN ST
LA CROSSE WI
54601-4200
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-0001
  • Fax: 608-785-0002
Mailing address:
  • Phone: 608-785-0001
  • Fax: 608-785-0002

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

VIII. Authorized Official

Name: MIKE BOEHM
Title or Position: CEO, PRESIDENT
Credential:
Phone: 608-785-0001