1437214335 NPI number — ABRIO FAMILY SERVICES & SUPPORTS

Table of content: (NPI 1437214335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437214335 NPI number — ABRIO FAMILY SERVICES & SUPPORTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABRIO FAMILY SERVICES & SUPPORTS
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:
ASKAN FOUNDATION CORPORATION
Provider Other Organization Name Type Code:
4
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:
1437214335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 E CORTLAND BLVD
Provider Second Line Business Mailing Address:
SUITE A15
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86004-9337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-779-9449
Provider Business Mailing Address Fax Number:
928-962-6432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 E CORTLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE A15
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86004-9337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-779-9449
Provider Business Practice Location Address Fax Number:
928-962-6432
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARGROVE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP/COO
Authorized Official Telephone Number:
928-779-9449

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 042705 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042705 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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