Provider Demographics
NPI:1932257524
Name:FAMILY RECOVERY CENTER FOUNDATION
Entity Type:Organization
Organization Name:FAMILY RECOVERY CENTER FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DRIECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLBOOK
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-535-0175
Mailing Address - Street 1:1420 E 17TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6283
Mailing Address - Country:US
Mailing Address - Phone:208-535-0175
Mailing Address - Fax:208-542-0125
Practice Address - Street 1:1420 E 17TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6283
Practice Address - Country:US
Practice Address - Phone:208-535-0175
Practice Address - Fax:208-542-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty