Provider Demographics
NPI:1558691824
Name:INTEGRATED FAMILY SERVICES
Entity Type:Organization
Organization Name:INTEGRATED FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:ORSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-294-2056
Mailing Address - Street 1:1684 W MACAW DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7449
Mailing Address - Country:US
Mailing Address - Phone:480-294-2056
Mailing Address - Fax:
Practice Address - Street 1:1684 W MACAW DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7449
Practice Address - Country:US
Practice Address - Phone:480-294-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1083765440Medicaid