Provider Demographics
NPI:1467658419
Name:NAMPA FAMILY JUSTICE CENTER
Entity Type:Organization
Organization Name:NAMPA FAMILY JUSTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-475-5700
Mailing Address - Street 1:1305 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3903
Mailing Address - Country:US
Mailing Address - Phone:208-475-5700
Mailing Address - Fax:208-475-5710
Practice Address - Street 1:1305 3RD ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3903
Practice Address - Country:US
Practice Address - Phone:208-475-5700
Practice Address - Fax:208-475-5710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF NAMPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-26
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807716900Medicaid