1730242389 NPI number — JEWISH FAMILY AND CHILDRENS SERVICE

Table of content: (NPI 1730242389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730242389 NPI number — JEWISH FAMILY AND CHILDRENS SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY AND CHILDRENS SERVICE
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:
6
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:
1730242389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4545 E SHEA BLVD
Provider Second Line Business Mailing Address:
174
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-3074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-279-7655
Provider Business Mailing Address Fax Number:
602-241-5756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 E SHEA BLVD
Provider Second Line Business Practice Location Address:
174
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-279-7655
Provider Business Practice Location Address Fax Number:
602-241-5756
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZENT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
602-279-7655

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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