Provider Demographics
NPI:1437214335
Name:ABRIO FAMILY SERVICES & SUPPORTS
Entity Type:Organization
Organization Name:ABRIO FAMILY SERVICES & SUPPORTS
Other - Org Name:ASKAN FOUNDATION CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-779-9449
Mailing Address - Street 1:5200 E CORTLAND BLVD
Mailing Address - Street 2:SUITE A15
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-9337
Mailing Address - Country:US
Mailing Address - Phone:928-779-9449
Mailing Address - Fax:928-962-6432
Practice Address - Street 1:5200 E CORTLAND BLVD
Practice Address - Street 2:SUITE A15
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-9337
Practice Address - Country:US
Practice Address - Phone:928-779-9449
Practice Address - Fax:928-962-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 253Z00000X, 320600000X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042705Medicaid
AZ042705OtherAHCCCS