Provider Demographics
NPI:1497815567
Name:FAMILY INVOLVEMENT CENTER
Entity Type:Organization
Organization Name:FAMILY INVOLVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALLAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-412-4095
Mailing Address - Street 1:5333 NORTH 7TH STREET
Mailing Address - Street 2:SUITE A130
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-412-4095
Mailing Address - Fax:602-393-1165
Practice Address - Street 1:5333 NORTH 7TH STREET
Practice Address - Street 2:SUITE A130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-412-4095
Practice Address - Fax:602-393-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2739251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid