Provider Demographics
NPI:1720037930
Name:FAMILY ADDICTION COMMUNITY TREATMENT SERVICES
Entity Type:Organization
Organization Name:FAMILY ADDICTION COMMUNITY TREATMENT SERVICES
Other - Org Name:FACTS/NEW ALTERNATIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:740-446-7866
Mailing Address - Street 1:45 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1632
Mailing Address - Country:US
Mailing Address - Phone:740-446-7866
Mailing Address - Fax:740-446-8014
Practice Address - Street 1:45 OLIVE ST
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1632
Practice Address - Country:US
Practice Address - Phone:740-446-7866
Practice Address - Fax:740-446-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1220251B00000X, 251G00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1220Medicaid