Family Health Services Corporation
Organization Active NPI Federally Qualified Health Center (FQHC) · Shoshone, ID
NPI 1558023614 · NPPES record last updated Oct 6, 2021
Key facts
- NPI
- 1558023614
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY HEALTH SERVICES CORPORATION
- Practice address
- 61 E Highway 24
Shoshone, ID 83352-5338 - Phone
- (208) 886-2381
- NPI assigned
- Oct 6, 2021
- Organization subpart
- No
Authorized official
- Name
- Stacey Blackwood
- Title
- Credentialing Specialist
- Phone
- (208) 737-6718
Other NPIs on the same Medicare enrollment 35
Facilities with the same owner 20
Practitioners 4
-
Erik Long, M.D.
-
Chelsea Jean Parish, LCSW
-
Sarah Rae French, LCSW
-
Deborah A Garbett, LCPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Federally qualified health center certification: CCN 131019
- Legal name
- FAMILY HEALTH SERVICES CORPORATION
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 22, 2022
- Last certification
- Nov 22, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 22, 1982 in ID
- Enrollment address
- 61 E Highway 24
RM 126
Shoshone, ID 83352-5338
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Aaron J Houston |
Corporate Officer |
Feb 26, 2013 | 100% |
| W-2 Managing Employee |
Feb 2, 2016 | 100% | |
| Chris Wingfield |
Corporate Officer |
Mar 1, 1999 | |
| Kandra Richardson |
Corporate Director |
Jan 25, 2022 | |
| Melody Lefler |
Corporate Director |
Feb 1, 2008 | |
| Jane Miller |
Corporate Director |
May 1, 2018 | |
| Andrew York |
Corporate Director |
Mar 1, 2020 | |
| Marta Hernandez |
Corporate Director |
Dec 1, 1999 | |
| Robert Agnew |
Corporate Officer |
Feb 4, 2019 | |
| Bonnie Hoag |
Corporate Director |
Mar 1, 2011 | |
| Family Health Services Corporation |
Operational/Managerial Control | Aug 5, 2021 | 100% |
| Janet K King |
Corporate Director |
Nov 15, 2015 | |
| Robert Bulkley |
Corporate Director |
Mar 17, 2017 | |
| John Lothspeich |
Corporate Director |
Jan 25, 2022 |
All facility ownership & control disclosures 20
| Facility | Type | Role | Since |
|---|---|---|---|
| Family Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 22, 1982 |
| Family Health Services Shoshone |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 22, 1982 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 15, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 15, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 25, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 20, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 30, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | May 21, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 12, 2019 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 29, 2020 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 2, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 12, 2022 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 1, 2023 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 4, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 4, 2021 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 25, 2023 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 8, 2024 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 22, 2024 |
| Family Health Services |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 14, 1982 |
| Family Health Services Corporation |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 14, 1982 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040216000531 | ID | Part B Supplier - Clinic/Group Practice | 7012815038 |
Receives reassigned benefits from 77 practitioners 35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kimberly, ID; Rupert, ID; Shoshone, ID; Twin Falls, ID; Bellevue, ID; Buhl, ID; Burley, ID; Declo, ID… |
| O20221216001419 | ID | Part a Provider - Federally Qualified Health Center (FQHC) | 7012815038 | Practice locations: Shoshone, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor |
101YS0200X | |||
| Social Worker |
104100000X | |||
| School Social Worker |
1041S0200X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
61 E Highway 24
Shoshone, ID 83352-5338
Mailing address
794 Eastland Dr
Twin Falls, ID 83301-6856
Phone (208) 735-9363
Other providers in Shoshone, ID
- Cascades at Lincoln County, LLC
- Charolais Care IV, Inc
- Martha Mary Clements
- Keith E Davis
- Katelyn Rose Denison
- Family Health Services Corporation
- Gooding Pharmacy Inc
- Barbara Hapayan
- Sara Jesse Harding
- Blaine Hawkes
All providers in Shoshone, ID · Federally Qualified Health Center (FQHC) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.