Provider Demographics
NPI:1821105115
Name:FAMILLE/FAMILLE, INC
Entity Type:Organization
Organization Name:FAMILLE/FAMILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SALAMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-428-8411
Mailing Address - Street 1:6431 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3840
Mailing Address - Country:US
Mailing Address - Phone:916-428-8411
Mailing Address - Fax:
Practice Address - Street 1:6431 HOGAN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3840
Practice Address - Country:US
Practice Address - Phone:916-428-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARCF00002FOtherMEDI-CAL