Provider Demographics
NPI:1477736817
Name:FAMILY SERVICES OF NORTHEAST, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICES OF NORTHEAST, INC.
Other - Org Name:HEALTHY FAMILIES
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-436-4360
Mailing Address - Street 1:1822 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2317
Mailing Address - Country:US
Mailing Address - Phone:920-436-4416
Mailing Address - Fax:920-436-8896
Practice Address - Street 1:300 CROOKS ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4527
Practice Address - Country:US
Practice Address - Phone:920-436-4360
Practice Address - Fax:920-437-3540
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICES OF N.E.W., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44018500Medicaid