Provider Demographics
NPI:1417493537
Name:FOUR OAKS FAMILY AND CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:FOUR OAKS FAMILY AND CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHISATO
Authorized Official - Middle Name:N
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:319-364-0259
Mailing Address - Street 1:5400 KIRKWOOD BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5216
Mailing Address - Country:US
Mailing Address - Phone:319-364-0259
Mailing Address - Fax:866-290-5565
Practice Address - Street 1:5400 KIRKWOOD BLVD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5216
Practice Address - Country:US
Practice Address - Phone:319-364-0259
Practice Address - Fax:866-290-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health