Basic Information
| Provider Information | |||||||||
| NPI: | 1518091743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY BUILDERS FOSTER CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 S FAIRWAY ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932778109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596851200 | ||||||||
| FaxNumber: | 5596859742 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 S FAIRWAY ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596851200 | ||||||||
| FaxNumber: | 5596859742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUBEAU | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5596851200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 547202600 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 01924308 | 05 | CA | MEDICAID |