1730245283 NPI number — FSL PROGRAMS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730245283 NPI number — FSL PROGRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FSL PROGRAMS
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:
1730245283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 E THOMAS RD
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:
85014-5734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-285-1800
Provider Business Mailing Address Fax Number:
602-285-1838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6010 W NORTHERN AVE
Provider Second Line Business Practice Location Address:
#800
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85301-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-931-0983
Provider Business Practice Location Address Fax Number:
623-939-2815
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
INIGUEZ
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC ASSISTANT
Authorized Official Telephone Number:
602-285-0505

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  ADHC-029 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ADHC-029 . This is a "ADHS LICENSE#" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: BH-847 . This is a "ADHS BEHAVIORAL" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 572439 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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