Provider Demographics
NPI:1457532616
Name:FAMILY & CHILDREN'S CENTER, INC
Entity Type:Organization
Organization Name:FAMILY & CHILDREN'S CENTER, INC
Other - Org Name:EMHS-VERNON COUNTY
Other - Org Type:Other Name
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 1:1321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1156
Practice Address - Country:US
Practice Address - Phone:608-637-7052
Practice Address - Fax:608-637-8500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & CHILDREN'S CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-16
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32980600Medicaid