Provider Demographics
NPI:1528502366
Name:FAMILY SUPPORT COUNCIL OF DOUGLAS COUNTY
Entity type:Organization
Organization Name:FAMILY SUPPORT COUNCIL OF DOUGLAS COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-8692
Mailing Address - Street 1:1255 WATERLOO LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-7403
Mailing Address - Country:US
Mailing Address - Phone:775-782-8692
Mailing Address - Fax:775-782-1942
Practice Address - Street 1:1255 WATERLOO LN
Practice Address - Street 2:UNIT A
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7403
Practice Address - Country:US
Practice Address - Phone:775-782-8692
Practice Address - Fax:775-782-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services