MEDICARE: FAMILY ADVOCACY AND CONSULTATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		UT

General Provider Information

NPI Number	:	1518136878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY ADVOCACY AND CONSULTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 13757
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84412-3757
Country	:	US
Telephone Number	:	801-627-1630
Fax Number	:	801-627-8174

Provider Business Practice Location Address
First Line	:	1020 TYLER AVE
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84404-6537
Country	:	US
Telephone Number	:	801-627-1630
Fax Number	:	801-627-8174

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MANDY L SHALE
Credential	:	M.ED., QMRP
Telephone Number	:	801-627-1630

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	04/20/2008

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