| Family Service Agency | |
|
10220 N 31st Ave Ste 103-105 Phoenix AZ 85051-9581 | |
| (602) 863-1862 | |
| (602) 863-4388 |
| Full Name | Family Service Agency |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 10220 N 31st Ave Ste 103-105, Phoenix, Arizona |
| Authorized Official Name and Position | Rose M Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Service Agency Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Family Service Agency 10220 N 31st Ave Ste 103-105 Phoenix AZ 85051-9581 Ph: (602) 863-1862 |
| NPI Number | 1255538732 |
|---|---|
| Provider Enumeration Date | 06/28/2007 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255538732 | NPI | - | NPPES |
| BH4241-OTC8910 | Other | AZ | ADHS/BMFL |
| 117178 | Other | AZ | AHCCCS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 251V00000X | Voluntary Or Charitable | BH-383 (Arizona) | Secondary |
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