Provider Demographics
NPI:1124153366
Name:LDS FAMILY SERVICES
Entity type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCHAUGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-327-6123
Mailing Address - Street 1:925 CANNERY CT STE A
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4058
Mailing Address - Country:US
Mailing Address - Phone:505-327-6123
Mailing Address - Fax:505-327-9562
Practice Address - Street 1:925 CANNERY CT STE A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4058
Practice Address - Country:US
Practice Address - Phone:505-327-6123
Practice Address - Fax:505-327-9562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)