Provider Demographics
NPI:1942325972
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES CA CONCORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-483-2154
Mailing Address - Street 1:1063 DETROIT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1063 DETROIT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2411
Practice Address - Country:US
Practice Address - Phone:925-685-2941
Practice Address - Fax:925-685-2958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)