General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871669903 NPI number — FRANCISCAN LIFE CENTER NETWORK

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:
FRANCISCAN LIFE CENTER NETWORK

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:
1871669903

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
01/27/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2955

Provider Second Line Business Mailing Address:
1745 POCATELLO CREEK

Provider Business Mailing Address City Name:
POCATELLO

Provider Business Mailing Address State Name:
ID

Provider Business Mailing Address Postal Code:
83206

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
208-233-9383

Provider Business Mailing Address Fax Number:
208-233-2707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1745 POCATELLO CREEK

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
POCATELLO

Provider Business Practice Location Address State Name:
ID

Provider Business Practice Location Address Postal Code:
83206

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
208-233-9383

Provider Business Practice Location Address Fax Number:
208-233-2707

Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOLLER

Authorized Official First Name:
MARY

Authorized Official Middle Name:
PAUL

Authorized Official Title or Position:
MARRIAGE &FAMILY THERAPIST

Authorized Official Telephone Number:
208-233-9383

Provider Taxonomy Codes

Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

1871669903 NPI number — FRANCISCAN LIFE CENTER NETWORK

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