Provider Demographics
NPI:1518166008
Name:FAMILY VISITOR PROGRAM
Entity Type:Organization
Organization Name:FAMILY VISITOR PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-945-1234
Mailing Address - Street 1:401 23RD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4363
Mailing Address - Country:US
Mailing Address - Phone:970-945-1234
Mailing Address - Fax:970-928-8328
Practice Address - Street 1:401 23RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4363
Practice Address - Country:US
Practice Address - Phone:970-945-1234
Practice Address - Fax:970-928-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54522536Medicaid