Basic Information
| Provider Information | |||||||||
| NPI: | 1104942218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIANCE FAMILY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 POLK ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087370572 | ||||||||
| FaxNumber: | 2087349441 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 POLK ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087349619 | ||||||||
| FaxNumber: | 2087349441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | STEPHENS | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2087370572 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 805539300 | 05 | ID | MEDICAID |