Provider Demographics
NPI:1083837710
Name:ALLIES FAMILY SOLUTIONS
Entity Type:Organization
Organization Name:ALLIES FAMILY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-234-2094
Mailing Address - Street 1:850 E LANDER ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5763
Mailing Address - Country:US
Mailing Address - Phone:208-234-2094
Mailing Address - Fax:208-234-2637
Practice Address - Street 1:850 E LANDER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5763
Practice Address - Country:US
Practice Address - Phone:208-234-2094
Practice Address - Fax:208-234-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8058128Medicaid