Provider Demographics
NPI:1982835062
Name:FAMILY & CHILDREN'S CENTER
Entity Type:Organization
Organization Name:FAMILY & CHILDREN'S CENTER
Other - Org Name:FAMILY & CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-785-0001
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:2118 CAMPUS DR SE
Practice Address - Street 2:STE. 100
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6492
Practice Address - Country:US
Practice Address - Phone:507-281-3508
Practice Address - Fax:507-536-9317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & CHILDREN'S CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)