Provider Demographics
NPI:1467549220
Name:FAMILY SUPPORT SERVICES INC.
Entity Type:Organization
Organization Name:FAMILY SUPPORT SERVICES INC.
Other - Org Name:ADULT REHABILITATIVE MENTAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-379-1750
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-4993
Mailing Address - Fax:651-379-1772
Practice Address - Street 1:1900 SILVER LAKE RD NW
Practice Address - Street 2:SUITE 115
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1786
Practice Address - Country:US
Practice Address - Phone:651-628-4993
Practice Address - Fax:651-379-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN520038500Medicaid