MEDICARE: ALLIANCE FAMILY SERVICES NORTH, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	101YP2500X	Professional Counselor
3	2084P0804X	Child & Adolescent Psychiatry Physician
4	106H00000X	Marriage & Family Therapist
5	261QD1600X	Developmental Disabilities Clinic/Center
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
7	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679796007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FAMILY SERVICES NORTH, INC.

Provider Business Mailing Address
First Line	:	608 S DIVISION AVE
Second Line	:
City	:	SANDPOINT
State	:	ID
Zip	:	83864-1749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 W MOANA LN
Second Line	:	SUITE 14
City	:	RENO
State	:	NV
Zip	:	89509-4775
Country	:	US
Telephone Number	:	775-337-2394
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TRACEY LANGE
Credential	:
Telephone Number	:	208-265-5049

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	02/23/2011

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Directions to “ALLIANCE FAMILY SERVICES NORTH, INC. ” Practice Location

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