Provider Demographics
NPI:1962658500
Name:SYRINGA FAMILY PARTNERSHIP, LLC
Entity Type:Organization
Organization Name:SYRINGA FAMILY PARTNERSHIP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:208-771-1551
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0844
Mailing Address - Country:US
Mailing Address - Phone:208-771-1551
Mailing Address - Fax:208-676-1030
Practice Address - Street 1:3650 N GOVERNMENT WAY
Practice Address - Street 2:SUITE L
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8331
Practice Address - Country:US
Practice Address - Phone:208-676-1693
Practice Address - Fax:208-676-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency