Provider Demographics
NPI:1437236445
Name:FAMILY SOLUTIONS
Entity Type:Organization
Organization Name:FAMILY SOLUTIONS
Other - Org Name:FAMILY FRIENDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-776-0497
Mailing Address - Street 1:322 NW F ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2052
Mailing Address - Country:US
Mailing Address - Phone:541-476-4248
Mailing Address - Fax:541-476-0288
Practice Address - Street 1:322 NW F ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2052
Practice Address - Country:US
Practice Address - Phone:541-476-4248
Practice Address - Fax:541-476-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR209981261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR209981OtherSTATE PROVIDER NUMBER
OR930875235OtherFEDERAL ID NUMBER
OR925369OtherBLUE CROSS INSURANCE