Provider Demographics
NPI:1609956697
Name:FSR INTERGRATIVE SERVICES, INC.
Entity Type:Organization
Organization Name:FSR INTERGRATIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAEGAN
Authorized Official - Middle Name:MARCHAND
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:623-931-9300
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85311-0127
Mailing Address - Country:US
Mailing Address - Phone:623-931-9300
Mailing Address - Fax:623-931-9691
Practice Address - Street 1:8037 N. 43RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:623-931-9300
Practice Address - Fax:623-931-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health