Provider Demographics
NPI:1710046255
Name:FOUR OAKS FAMILY & CHILDREN SERVICES
Entity Type:Organization
Organization Name:FOUR OAKS FAMILY & CHILDREN SERVICES
Other - Org Name:FOUR OAKS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM MANAGER BEHAVIOR HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-364-4593
Mailing Address - Street 1:5400 KIRKWOOD BLVD SW
Mailing Address - Street 2:FOUR OAKS
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-364-0259
Mailing Address - Fax:866-290-5565
Practice Address - Street 1:5400 KIRKWOOD BLVD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-364-0259
Practice Address - Fax:866-290-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251S00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========Medicaid