Provider Demographics
NPI:1174035950
Name:FAMILY SUBSTITUTES
Entity Type:Organization
Organization Name:FAMILY SUBSTITUTES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ WELLNESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-308-9183
Mailing Address - Street 1:3797 N 3550 E
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5093
Mailing Address - Country:US
Mailing Address - Phone:208-308-9183
Mailing Address - Fax:
Practice Address - Street 1:3797 N 3550 E
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:ID
Practice Address - Zip Code:83341-5093
Practice Address - Country:US
Practice Address - Phone:208-308-9183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)