Provider Demographics
NPI:1396046835
Name:A TO Z FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:A TO Z FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRENOUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CIBI ACADC
Authorized Official - Phone:208-785-1326
Mailing Address - Street 1:44 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1200
Mailing Address - Country:US
Mailing Address - Phone:208-766-2389
Mailing Address - Fax:208-766-2385
Practice Address - Street 1:44 N MAIN
Practice Address - Street 2:
Practice Address - City:MALAD
Practice Address - State:ID
Practice Address - Zip Code:83252
Practice Address - Country:US
Practice Address - Phone:208-766-2389
Practice Address - Fax:208-766-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1700036019Medicaid