Provider Demographics
NPI:1831481829
Name:FAMILY HEALTH & SUPPORT NETWORK, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH & SUPPORT NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-2442
Mailing Address - Street 1:74410 HIGHWAY 111
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4157
Mailing Address - Country:US
Mailing Address - Phone:760-340-2442
Mailing Address - Fax:760-773-6475
Practice Address - Street 1:74410 HIGHWAY 111
Practice Address - Street 2:SUITE D
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4157
Practice Address - Country:US
Practice Address - Phone:760-340-2442
Practice Address - Fax:760-773-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
CA336413117253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health