1104906098 NPI number — LDS FAMILY SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104906098 NPI number — LDS FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LDS FAMILY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LDS FAMILY SERVICES CA FOUNTAIN VALLEY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104906098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17350 MOUNT HERRMANN ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-4114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-444-3463
Provider Business Mailing Address Fax Number:
714-444-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17350 MOUNT HERRMANN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-4114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-444-3463
Provider Business Practice Location Address Fax Number:
714-444-1768
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUISKEN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
HUNTER
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
714-444-3463

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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