Provider Demographics
NPI:1275598054
Name:FAMILY RESOURCES INC
Entity Type:Organization
Organization Name:FAMILY RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MENTAL HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-468-2145
Mailing Address - Street 1:1414 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2148
Mailing Address - Country:US
Mailing Address - Phone:563-326-6431
Mailing Address - Fax:563-326-2013
Practice Address - Street 1:1414 W LOMBARD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2148
Practice Address - Country:US
Practice Address - Phone:563-326-6431
Practice Address - Fax:563-326-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X, 320900000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1102749Medicaid
IA0465559Medicaid
IA0102749Medicaid