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General NPI Number Information
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NPI Number | 1487960167
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Entity Type | Organization
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Legal Business Name | FAMILY & CHILDREN'S CENTER, INC.
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1707 MAIN ST
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City | LA CROSSE
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State | WI
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Zip | 54601-4200
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Country | US
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Telephone | 608-785-0001
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Fax | 608-785-0002
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Provider Business Mailing Address
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Address Line | 1707 MAIN ST
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City | LA CROSSE
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State | WI
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Zip | 54601-4200
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Country | US
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Telephone | 608-785-0001
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Fax | 608-785-0002
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MIKE BOEHM
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Credential |
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Telephone | 608-785-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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