Provider Demographics
NPI:1851858617
Name:FOUR OAKS FAMILY AND CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:FOUR OAKS FAMILY AND CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:193-640-2593
Mailing Address - Street 1:5400 KIRKWOOD BLVD SW
Mailing Address - Street 2:CAMBRIDGE PROGRAM
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5298
Mailing Address - Country:US
Mailing Address - Phone:319-364-0259
Mailing Address - Fax:866-290-5565
Practice Address - Street 1:80 NORTH EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:319-364-0259
Practice Address - Fax:866-908-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility