Provider Demographics
NPI:1225403280
Name:BLACK FAMILY AND CHILD SERVICES INC
Entity Type:Organization
Organization Name:BLACK FAMILY AND CHILD SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL FOSTER CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6022-243-1773
Mailing Address - Street 1:409 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6311
Mailing Address - Country:US
Mailing Address - Phone:602-243-1773
Mailing Address - Fax:602-276-1984
Practice Address - Street 1:409 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6311
Practice Address - Country:US
Practice Address - Phone:602-243-1773
Practice Address - Fax:602-276-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ520668253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency