Provider Demographics
NPI:1790124907
Name:NORTHERN FAMILY INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHERN FAMILY INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-6448
Mailing Address - Street 1:405 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1859
Mailing Address - Country:US
Mailing Address - Phone:989-732-6448
Mailing Address - Fax:
Practice Address - Street 1:407 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735
Practice Address - Country:US
Practice Address - Phone:989-732-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health