Provider Demographics
NPI:1891320271
Name:THE FAMILY HOUSE, LLC
Entity Type:Organization
Organization Name:THE FAMILY HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:3017 W PECAN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4429
Mailing Address - Country:US
Mailing Address - Phone:207-482-9832
Mailing Address - Fax:602-314-6768
Practice Address - Street 1:3017 W PECAN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4429
Practice Address - Country:US
Practice Address - Phone:207-482-9832
Practice Address - Fax:602-314-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness