Provider Demographics
NPI:1659483915
Name:FERNBROOK FAMILY CENTER, INC
Entity type:Organization
Organization Name:FERNBROOK FAMILY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-446-0431
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0977
Mailing Address - Country:US
Mailing Address - Phone:507-446-0431
Mailing Address - Fax:507-446-8014
Practice Address - Street 1:115 LANDMARK DR NE
Practice Address - Street 2:SUITE 1
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5702
Practice Address - Country:US
Practice Address - Phone:507-446-0431
Practice Address - Fax:507-446-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN021M3FEOtherBCBS
MN167843OtherUCARE/SCHA