Provider Demographics
NPI:1750689741
Name:FAMILY ARIZEN CORP
Entity Type:Organization
Organization Name:FAMILY ARIZEN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-389-2064
Mailing Address - Street 1:530 E. MAIN STREET
Mailing Address - Street 2:SUITE 720
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2322
Mailing Address - Country:US
Mailing Address - Phone:804-389-2064
Mailing Address - Fax:804-782-8627
Practice Address - Street 1:530 E MAIN ST
Practice Address - Street 2:SUITE 730
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2418
Practice Address - Country:US
Practice Address - Phone:804-389-2064
Practice Address - Fax:804-782-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1531-05-001305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1531-05-001Medicaid