NPIMap

Organization Active NPI

Family Health Services Corporation

  • School Social Worker
  • Twin Falls, ID
National Provider Identifier
1679238190
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Social WorkerTaxonomy code 1041S0200X
Legal business name
FAMILY HEALTH SERVICES CORPORATION
Practice address
644 Caswell Ave W
Twin Falls, ID 83301-3707
Phone
(208) 733-4875
Fax
(208) 734-1282
NPI assigned
Nov 1, 2021
Last updated
Nov 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey Blackwood
Title
Credentialing Specialist
Phone
(208) 737-6718

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
School Counselor 101YS0200X NU
Clinical Social Worker 1041C0700X NU
School Social Worker 1041S0200X NU Primary
Marriage & Family Therapist 106H00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU

Addresses

Primary practice location

644 Caswell Ave W
Twin Falls, ID 83301-3707

Mailing address

794 Eastland Dr
Twin Falls, ID 83301-6856
Phone (208) 737-6718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20221216001618 ID Part A Provider - Federally Qualified Health Center (FQHC) 7012815038 Practice locations: Twin Falls, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679238190. Details of each certification follow.

Federally qualified health center certification: CCN 131020

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
CorporationNon-profit
Incorporated
Jul 30, 2021 in ID
Enrollment address
644 Caswell Ave W
RM 100
Twin Falls, ID 83301-3707

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

National Provider Directory

National Provider Directory
Tax ID family
Family Health Serv34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Locations

644 Caswell Ave W
Twin Falls, ID 83301
Phone (208) 733-4875

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Aaron J Houston Individual Corporate OfficerCeo Feb 26, 2013 100%
W-2 Managing EmployeeCeo Feb 2, 2016 100%
Chris Wingfield Individual Corporate DirectorCio Mar 1, 1999
Kandra Richardson Individual Corporate DirectorBoard Member Jan 25, 2022
Melody Lefler Individual Corporate DirectorBoard Member - President Feb 1, 2008
Jane Miller Individual Corporate DirectorBoard Member May 1, 2018
Andrew York Individual Corporate DirectorBoard Member Mar 1, 2020
Marta Hernandez Individual Corporate DirectorBoard Member Dec 1, 1999
Robert Agnew Individual Corporate OfficerCfo Feb 4, 2019
Bonnie Hoag Individual Corporate DirectorBoard Member - Vice President Mar 1, 2011
Family Health Services Corporation Organization, Twin Falls, ID Corporation, For-profit Operational/Managerial Control Jul 30, 2021 100%
Janet K King Individual Corporate DirectorBoard Member Nov 15, 2015
Robert Bulkley Individual Corporate DirectorBoard Member Mar 17, 2017
John Lothspeich Individual Corporate DirectorBoard Member Jan 25, 2022

All facility ownership & control disclosures 20

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Health ServicesTwin Falls, ID, CCN 131875 Federally qualified health center Operational/Managerial Control (100%) Feb 22, 1982
Family Health Services ShoshoneShoshone, ID, CCN 131894 Federally qualified health center Operational/Managerial Control (100%) Feb 22, 1982
Family Health Services CorporationTwin Falls, ID, CCN 131011 Federally qualified health center Operational/Managerial Control (100%) May 15, 2020
Family Health Services CorporationTwin Falls, ID, CCN 131017 Federally qualified health center Operational/Managerial Control (100%) May 15, 2020
Family Health Services CorporationJerome, ID, CCN 131016 Federally qualified health center Operational/Managerial Control (100%) Oct 25, 2022
Family Health Services CorporationTwin Falls, ID, CCN 131014 Federally qualified health center Operational/Managerial Control (100%) May 20, 2020
Family Health Services CorporationShoshone, ID, CCN 131019 Federally qualified health center Operational/Managerial Control (100%) Aug 5, 2021
Family Health Services CorporationDeclo, ID, CCN 131023 Federally qualified health center Operational/Managerial Control (100%) May 21, 2021
Family Health Services CorporationBurley, ID, CCN 131024 Federally qualified health center Operational/Managerial Control (100%) Jun 12, 2019
Family Health Services CorporationBurley, ID, CCN 131026 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2020
Family Health Services CorporationBuhl, ID, CCN 131028 Federally qualified health center Operational/Managerial Control (100%) Aug 2, 2022
Family Health Services CorporationBuhl, ID, CCN 131027 Federally qualified health center Operational/Managerial Control (100%) Apr 12, 2022
Family Health Services CorporationJerome, ID, CCN 131031 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2023
Family Health Services CorporationKimberly, ID, CCN 131038 Federally qualified health center Operational/Managerial Control (100%) Aug 4, 2021
Family Health Services CorporationKimberly, ID, CCN 131037 Federally qualified health center Operational/Managerial Control (100%) Aug 4, 2021
Family Health Services CorporationTwin Falls, ID, CCN 131040 Federally qualified health center Operational/Managerial Control (100%) Oct 25, 2023
Family Health Services CorporationTwin Falls, ID, CCN 131043 Federally qualified health center Operational/Managerial Control (100%) Apr 8, 2024
Family Health Services CorporationTwin Falls, ID, CCN 131046 Federally qualified health center Operational/Managerial Control (100%) Oct 22, 2024
Family Health ServicesKimberly, ID, CCN 131050 Federally qualified health center Operational/Managerial Control (100%) Jun 14, 1982
Family Health Services CorporationKimberly, ID, CCN 131052 Federally qualified health center Operational/Managerial Control (100%) Jun 14, 1982

Facilities with the same owner 20

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 20

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1679238190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-737-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 CASWELL AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013707",
            "telephone_number": "208-733-4875",
            "fax_number": "208-734-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "BLACKWOOD",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "208-737-6718"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.