Provider Demographics
NPI:1285038794
Name:CHRISTIAN FAMILY CARE
Entity Type:Organization
Organization Name:CHRISTIAN FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HCTC PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:480-293-4022
Mailing Address - Street 1:305 W CYPRESS STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003
Mailing Address - Country:US
Mailing Address - Phone:480-293-4022
Mailing Address - Fax:
Practice Address - Street 1:305 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1104
Practice Address - Country:US
Practice Address - Phone:480-293-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5662295251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management