1649807298 NPI number — SOS FOR FAMILIES, LLC

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 1649807298 NPI number — SOS FOR FAMILIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOS FOR FAMILIES, LLC
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:
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:
1649807298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
536 S KELLY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-7194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-640-4339
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 E SCHNEIDMILLER AVE STE 141
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-7989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-981-0515
Provider Business Practice Location Address Fax Number:
208-981-0514
Provider Enumeration Date:
03/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENSON
Authorized Official First Name:
BENNY
Authorized Official Middle Name:
KELL
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
208-640-4339

Provider Taxonomy Codes

  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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