Provider Demographics
NPI:1568596062
Name:FAMILY CARE CENTER, INC
Entity Type:Organization
Organization Name:FAMILY CARE CENTER, INC
Other - Org Name:FAMILY CARE CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGARAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCP-69
Authorized Official - Phone:208-529-8832
Mailing Address - Street 1:310 N 2ND E STE 114
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1606
Mailing Address - Country:US
Mailing Address - Phone:208-359-0581
Mailing Address - Fax:208-359-1125
Practice Address - Street 1:1740 E 17TH ST STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6375
Practice Address - Country:US
Practice Address - Phone:208-529-8832
Practice Address - Fax:208-522-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8J513OtherBLUE CROSS OF IDAHO
ID000010006240OtherBLUE SHIELD OF IDAHO