Provider Demographics
NPI:1124237367
Name:CHILD AND FAMILY RESOURCE
Entity type:Organization
Organization Name:CHILD AND FAMILY RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-356-4911
Mailing Address - Street 1:316 N 3RD E
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1661
Mailing Address - Country:US
Mailing Address - Phone:208-356-4911
Mailing Address - Fax:208-356-5044
Practice Address - Street 1:316 N 3RD E
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1661
Practice Address - Country:US
Practice Address - Phone:208-356-4911
Practice Address - Fax:208-356-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation