1154668796 NPI number — SUSAN F. FALCK, MSW, LCSW, PC

Table of content: (NPI 1154668796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154668796 NPI number — SUSAN F. FALCK, MSW, LCSW, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN F. FALCK, MSW, LCSW, PC
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:
Provider Other Organization Name Type Code:
6
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:
1154668796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1837
Provider Second Line Business Mailing Address:
7583 MAIN ST
Provider Business Mailing Address City Name:
BONNERS FERRY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83805-1837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-946-9572
Provider Business Mailing Address Fax Number:
208-267-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7583 MAIN ST
Provider Second Line Business Practice Location Address:
HAWKINS HOUSE HEALING CENTER
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-946-9572
Provider Business Practice Location Address Fax Number:
208-267-9020
Provider Enumeration Date:
01/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FALCK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWMER/PRESIDENT/PROVIDER
Authorized Official Telephone Number:
208-946-9572

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376861138 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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