Provider Demographics
NPI:1760005045
Name:FAMILY ALLIANCE NETWORK LLC
Entity Type:Organization
Organization Name:FAMILY ALLIANCE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-446-3221
Mailing Address - Street 1:5206 CYPRESS CREEK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4405
Mailing Address - Country:US
Mailing Address - Phone:832-446-3221
Mailing Address - Fax:832-666-2975
Practice Address - Street 1:5206 CYPRESS CREEK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4405
Practice Address - Country:US
Practice Address - Phone:832-446-3221
Practice Address - Fax:832-666-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376635401Medicaid