Provider Demographics
| NPI: | 1275206575 |
|---|---|
| Name: | ARIZONA FAMILY HEALTH SERVICES LLC |
| Entity Type: | Organization |
| Organization Name: | ARIZONA FAMILY HEALTH SERVICES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | SR PROGRAM MANAGER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | THEOPHILUS |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | FABULUJE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 602-727-7659 |
| Mailing Address - Street 1: | 5534 W WINSTON DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAVEEN |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85339-5256 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-727-7659 |
| Mailing Address - Fax: | 602-687-7602 |
| Practice Address - Street 1: | 3201 W PEORIA AVE STE C600 |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85029-4611 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-727-7659 |
| Practice Address - Fax: | 602-687-7602 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2021-08-01 |
| Last Update Date: | 2024-04-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251E00000X | Agencies | Home Health | |
| No | 253J00000X | Agencies | Foster Care Agency | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
