Provider Demographics
NPI:1205029840
Name:FAMILY SERVICE CORPORATION, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE CORPORATION, INC.
Other - Org Name:FSC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:JAKES
Authorized Official - Suffix:SR
Authorized Official - Credentials:BFA
Authorized Official - Phone:985-974-1862
Mailing Address - Street 1:1425 LYNN ST # A
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4416
Mailing Address - Country:US
Mailing Address - Phone:985-448-3454
Mailing Address - Fax:
Practice Address - Street 1:1425 LYNN ST # A
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4416
Practice Address - Country:US
Practice Address - Phone:985-448-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACM 6901251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714267Medicaid