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General NPI Number Information
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NPI Number | 1255964730
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Entity Type | Organization
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Legal Business Name | FAMILY BUILDING BLOCKS
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 2425 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97305-1220
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Country | US
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Telephone | 503-566-2132
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97305-1220
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Country | US
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Telephone | 503-566-2132
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BENJAMIN FENNIMORE
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Credential | LCSW
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Telephone | 503-566-2132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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