Organization
FAMILY SOLUTIONS
Active
Other names
Family Friends
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY PROVENCIO (CHIEF OPERATING OFFICER)
(541) 776-0497
Entity
Organization
Contact information
Practice address
322 NW F ST, GRANTS PASS, OR 97526-2052
(541) 476-4248
(541) 476-0288
Mailing address
322 NW F ST, GRANTS PASS, OR 97526-2052
(541) 476-4248
(541) 476-0288
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
209981
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209981
STATE PROVIDER NUMBER
OR
01
—
925369
BLUE CROSS INSURANCE
OR
01
—
930875235
FEDERAL ID NUMBER
OR
Enumeration date
11/01/2006
Last updated
11/15/2016
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