Provider Demographics
NPI:1316009145
Name:JEWISH FAMILY & CHILDRENS SERVICE
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDRENS SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA, LCSW
Authorized Official - Phone:602-279-7655
Mailing Address - Street 1:4747 N 7TH ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3653
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:602-241-5756
Practice Address - Street 1:5701 W TALAVI BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1886
Practice Address - Country:US
Practice Address - Phone:623-486-8202
Practice Address - Fax:623-486-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6217251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ365563Medicaid
AZZWCMBNMedicare PIN