Provider Demographics
NPI:1821788399
Name:THE FAMILY HOUSE BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:THE FAMILY HOUSE BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGABO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-482-9832
Mailing Address - Street 1:5518 W CARSON RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2270
Mailing Address - Country:US
Mailing Address - Phone:207-482-9832
Mailing Address - Fax:
Practice Address - Street 1:1323 S 173RD LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1949
Practice Address - Country:US
Practice Address - Phone:207-482-9832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness