Organization
FOURTH AVENUE HOMES INC.
Active
Other names
First Step Quality Services
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA JOANNE SHRIVER (CEO)
(320) 231-2738
Entity
Organization
Contact information
Practice address
140 4TH AVE, SPICER, MN 56288-9673
(320) 796-2905
Mailing address
140 4TH AVE, SPICER, MN 56288-9673
(320) 796-2905
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
804433
MN
Other
Enumeration date
01/16/2008
Last updated
04/15/2008
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