Provider Demographics
NPI:1568592640
Name:CHRISTIAN FAMILY SERVICES
Entity Type:Organization
Organization Name:CHRISTIAN FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL FOSTER PARENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-299-5965
Mailing Address - Street 1:15415 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4242
Mailing Address - Country:US
Mailing Address - Phone:602-299-5965
Mailing Address - Fax:
Practice Address - Street 1:15415 N 45TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4242
Practice Address - Country:US
Practice Address - Phone:602-299-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11078322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158115OtherTHERAPEUTIC FOSTER CARE