Provider Demographics
NPI:1871816405
Name:MOUNTAIN CIRCLE FAMILY SERVICES
Entity Type:Organization
Organization Name:MOUNTAIN CIRCLE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROSSINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT INTERN
Authorized Official - Phone:530-284-7007
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0554
Mailing Address - Country:US
Mailing Address - Phone:530-284-7007
Mailing Address - Fax:530-284-7111
Practice Address - Street 1:312 CRESCENT STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947-0554
Practice Address - Country:US
Practice Address - Phone:530-284-7007
Practice Address - Fax:530-284-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency