Provider Demographics
NPI:1720654320
Name:FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER, INC.
Other - Org Name:LAKEVIEW RCF
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-5925
Mailing Address - Street 1:925 STATE ROUTE VV
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3822
Mailing Address - Country:US
Mailing Address - Phone:573-888-5925
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 2070
Practice Address - Street 2:
Practice Address - City:WAPPAPELLO
Practice Address - State:MO
Practice Address - Zip Code:63966-9508
Practice Address - Country:US
Practice Address - Phone:573-222-8676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility