Provider Demographics
NPI:1184989162
Name:INSTITUTE FOR FAMILY CENTERED SEVICES, INC
Entity type:Organization
Organization Name:INSTITUTE FOR FAMILY CENTERED SEVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & SR ASSISTANT GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RODENBERG-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-836-2234
Mailing Address - Street 1:313 CONGRESS ST
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1218
Mailing Address - Country:US
Mailing Address - Phone:919-367-9200
Mailing Address - Fax:
Practice Address - Street 1:200 KENT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3753
Practice Address - Country:US
Practice Address - Phone:301-934-5607
Practice Address - Fax:301-934-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5908001-06Medicaid