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General NPI Number Information
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NPI Number | 1285858555
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE TAHOE FAMILY RESOURCE CENTER
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3501 SPRUCE AVE STE B
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-2302
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Country | US
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Telephone | 530-542-0740
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 SPRUCE AVE STE B
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-2302
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Country | US
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Telephone | 530-542-0740
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DELICIA SPEES
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Credential |
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Telephone | 530-542-0740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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