Provider Demographics
NPI:1336500636
Name:FAMILY TREE HEALTHCARE LLC
Entity Type:Organization
Organization Name:FAMILY TREE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAWANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-859-1999
Mailing Address - Street 1:7002 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5423
Mailing Address - Country:US
Mailing Address - Phone:602-449-4221
Mailing Address - Fax:602-268-6298
Practice Address - Street 1:7002 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5423
Practice Address - Country:US
Practice Address - Phone:602-449-4221
Practice Address - Fax:602-268-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854053Medicaid
AZ028879Medicaid
AZ854053Medicaid