Provider Demographics
NPI:1700258639
Name:FAMILY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:FAMILY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-673-4354
Mailing Address - Street 1:300 JERRYS DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1132
Mailing Address - Country:US
Mailing Address - Phone:541-673-4354
Mailing Address - Fax:541-229-0623
Practice Address - Street 1:300 JERRYS DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1132
Practice Address - Country:US
Practice Address - Phone:541-673-4354
Practice Address - Fax:541-229-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare