| Family Care Center, Llc | |
|
1910 S Stapley Dr Ste 209 Mesa AZ 85204-6679 | |
| (719) 540-2100 | |
| Not Available |
| Full Name | Family Care Center, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1910 S Stapley Dr Ste 209, Mesa, Arizona |
| Authorized Official Name and Position | Christian M Ellis (PROVIDER ENGAGEMENT & CREDENTIALING) |
| Authorized Official Contact | 7655402100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Care Center, Llc 2860 S Circle Dr Ste 109 Colorado Springs CO 80906-4195 Ph: (719) 540-2100 | Family Care Center, Llc 1910 S Stapley Dr Ste 209 Mesa AZ 85204-6679 Ph: (719) 540-2100 |
| NPI Number | 1598535288 |
|---|---|
| Provider Enumeration Date | 01/04/2024 |
| Last Update Date | 11/07/2024 |
| Certification Date | 11/07/2024 |
| Medicare PECOS PAC ID | 5991064420 |
|---|---|
| Medicare Enrollment ID | O20240903000480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598535288 | NPI | - | NPPES |
| Provider Name | Heidi J Quinlan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851310932 PECOS PAC ID: 9830549831 Enrollment ID: I20240102004034 |
| Provider Name | Mireille Beauchaine Reece |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841434123 PECOS PAC ID: 3476603416 Enrollment ID: I20240821004276 |
| Provider Name | Charles Lee Weber |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841277258 PECOS PAC ID: 1254600935 Enrollment ID: I20241112001648 |
| Provider Name | Dollmarie Adorno Rondon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255684320 PECOS PAC ID: 0345775623 Enrollment ID: I20241122002931 |
| Provider Name | Belinda Ufei Fomba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194434738 PECOS PAC ID: 2264898816 Enrollment ID: I20241123000041 |
| Provider Name | Cordell Thomas Cheret |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194375352 PECOS PAC ID: 4981139177 Enrollment ID: I20241125003031 |
| Provider Name | Tyson Karl Lippe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164804282 PECOS PAC ID: 7113216888 Enrollment ID: I20241205002794 |
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