1427380385 NPI number — FAMILY SERVICE AGENCY

Table of content: (NPI 1427380385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427380385 NPI number — FAMILY SERVICE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427380385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N CENTRAL AVE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-1315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-264-9891
Provider Business Mailing Address Fax Number:
604-234-2639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
943 S GILBERT RD
Provider Second Line Business Practice Location Address:
STE. 400
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-264-9891
Provider Business Practice Location Address Fax Number:
602-234-2639
Provider Enumeration Date:
02/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWMAN-ROGERS
Authorized Official First Name:
SORREL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
602-264-9891

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)