Provider Demographics
NPI:1104825702
Name:FRIENDSHIP COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:FRIENDSHIP COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:PEOPLE OF COLOR NETWORK INC (IN ERROR)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:623-247-0464
Mailing Address - Street 1:1107 E TONTO ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4032
Mailing Address - Country:US
Mailing Address - Phone:602-241-6656
Mailing Address - Fax:602-241-7506
Practice Address - Street 1:1107 TONTO ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034
Practice Address - Country:US
Practice Address - Phone:602-241-6656
Practice Address - Fax:602-241-7506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICANOS POR LA CAUSA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-18
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2465261QM0801X
AZOTC7814261QM0801X
AZ261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
034682Medicare UPIN
AZ834899Medicaid