Provider Demographics
NPI:1881680254
Name:JEWISH FAMILY & CHILDRENS SERVICE
Entity Type:Organization
Organization Name:JEWISH FAMILY & CHILDRENS SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA, LCSW
Authorized Official - Phone:602-279-7655
Mailing Address - Street 1:4747 N. 7TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:602-264-1806
Practice Address - Street 1:880 N COLORADO ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-2239
Practice Address - Country:US
Practice Address - Phone:480-820-0825
Practice Address - Fax:480-820-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6829251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC9890OtherADHS STATE LICENSE
AZ004243Medicaid