Provider Demographics
NPI:1205814381
Name:FAMILY SELF HELP CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY SELF HELP CENTER, INC.
Other - Org Name:LAFAYETTE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MALINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:417-782-1772
Mailing Address - Street 1:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64802-1765
Mailing Address - Country:US
Mailing Address - Phone:417-782-1772
Mailing Address - Fax:417-782-3832
Practice Address - Street 1:1809 S CONNOR AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1837
Practice Address - Country:US
Practice Address - Phone:417-782-1772
Practice Address - Fax:417-782-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3082-8493324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========02OtherSTATE AGENCIES