Provider Demographics
NPI:1215084454
Name:FAMILY ADVOCACY RESOURCES
Entity type:Organization
Organization Name:FAMILY ADVOCACY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-438-4214
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276-0410
Mailing Address - Country:US
Mailing Address - Phone:515-438-4214
Mailing Address - Fax:515-438-4217
Practice Address - Street 1:124 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276
Practice Address - Country:US
Practice Address - Phone:515-438-4214
Practice Address - Fax:515-438-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02516101YM0800X
IA00417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0266981Medicaid
IA0266627Medicaid
IA0266981Medicaid