Provider Demographics
NPI:1821499104
Name:BLACK FAMILY AND CHILD SERVICES INC
Entity Type:Organization
Organization Name:BLACK FAMILY AND CHILD SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-243-1773
Mailing Address - Street 1:1522 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3543
Mailing Address - Country:US
Mailing Address - Phone:602-243-1773
Mailing Address - Fax:602-276-1984
Practice Address - Street 1:11120 W VAN BUREN ST APT 2117
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-7304
Practice Address - Country:US
Practice Address - Phone:602-243-1773
Practice Address - Fax:602-276-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4868156251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health