Provider Demographics
NPI:1134473416
Name:CCFX,LLC
Entity Type:Organization
Organization Name:CCFX,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARYLE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:602-206-6999
Mailing Address - Street 1:2622 E JAVELINA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7127
Mailing Address - Country:US
Mailing Address - Phone:602-206-6999
Mailing Address - Fax:
Practice Address - Street 1:2622 E JAVELINA CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7127
Practice Address - Country:US
Practice Address - Phone:602-206-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine