Provider Demographics
NPI:1023483211
Name:THE FAMILY TABLE, INC.
Entity type:Organization
Organization Name:THE FAMILY TABLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AMES
Authorized Official - Last Name:HEINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-855-9302
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0039
Mailing Address - Country:US
Mailing Address - Phone:208-855-9302
Mailing Address - Fax:208-855-9303
Practice Address - Street 1:1005 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5951
Practice Address - Country:US
Practice Address - Phone:208-855-9302
Practice Address - Fax:208-855-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health